Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Dane C Wallace, NURSEPRACTITIONER

Individual provider Family Nurse Practitioner · NPI 1528787744

Dr. Dane C Wallace, NURSEPRACTITIONER is a Nurse Practitioner in Edwardsville, Illinois. Qualified in 2022, 4 years ago. Practices with Cepamerica Illinois LLP, a 493-clinician group and accepts Medicare assignment. Licensed in Illinois and Missouri.

Years since qualifying
4
Licensed in
IL, MO
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

529 Hillsboro Ave
Edwardsville, IL 62025-1864
Phone: (217) 621-8675
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 209.025563 (IL)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 2023036829 (MO)

Record details

NPI number1528787744
Entity typeIndividual (Type 1)
GenderMale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedAugust 22, 2022
Last updated in NPPESNovember 6, 2023
Certification dateNovember 6, 2023
Mailing address529 Hillsboro Ave, Edwardsville, IL 62025-1864

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Cepamerica Illinois Llp — 493 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Edwardsville