Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charlesetta Wallace, APRN, CNM

Individual provider Advanced Practice Midwife · NPI 1114896032

Charlesetta Wallace, APRN, CNM is a Certified Nurse Midwife (CNM) in Bloomington, Illinois. Qualified in 2025, 1 year ago. Licensed in Illinois.

Years since qualifying
1
Licensed in
IL
In the registry since
2025
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.
CNM — Certified Nurse-Midwife
An advanced practice nurse who provides prenatal care and delivers babies.

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Practice location Address checks out

2111 E Oakland Ave Ste B
Bloomington, IL 61701-5783
Phone: (309) 808-3068
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Advanced Practice Midwife (primary) Taxonomy 367A00000X · Licence 209033647 (IL)

Record details

NPI number1114896032
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRN , CNM
Sole proprietorNo
NPI enumeratedOctober 30, 2025
Last updated in NPPESOctober 30, 2025
Certification dateOctober 30, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED NURSE MIDWIFE (CNM)
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

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