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

Elizabeth Nicole Wallis, MD

Individual provider Pediatrics Physician · NPI 1821551334

Elizabeth Nicole Wallis, MD is a Pediatrics Physician in Bloomington, Illinois. Licensed in Illinois and Louisiana. Registered with an NPI since 2019.

Licensed in
IL, LA
In the registry since
2019
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

200 W Monroe St Ste 302
Bloomington, IL 61701-3997
Phone: (309) 204-6766
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 331615 (LA)
Pediatrics Physician Taxonomy 208000000X · Licence 036.176418 (IL)

Record details

NPI number1821551334
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 11, 2019
Last updated in NPPESAugust 3, 2026
Certification dateAugust 3, 2026

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