Individual provider · Type 1 NPI

Shereece Nichole Wallace, DNP, AGPCNP-BC

Nurse Practitioner · Alton, IL

NPI number 1104338318 Active

Practice location

1 Memorial Dr
Alton, IL 62002-6722

Call (618) 463-7240 Map

Mailing address

660 Mason Ridge Center Dr Ste 300
St. Louis, MO 63141-8512

Other practice locations

  • 4500 Memorial Dr, Belleville, IL 62226-5360 · (618) 257-6220
  • 11155 Dunn Rd Ste 109N, St. Louis, MO 63136-6148 · (314) 953-8799
  • 2122 Troy Rd Ste 130, Edwardsville, IL 62025-2540 · (618) 800-4500
  • 11133 Dunn Rd, St. Louis, MO 63136-6163 · (314) 653-5000

Specialties and licenses

TaxonomyCodeLicense
Adult Health Nurse Practitioner 363LA2200X209017027 (IL)
Nurse Practitioner Primary 363L00000X209017027 (IL)
Adult Health Nurse Practitioner 363LA2200X2017038282 (MO)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1104338318

Shereece Nichole Wallace, DNP, AGPCNP-BC's National Provider Identifier is 1104338318, issued on Oct 27, 2017. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Alton, IL. The record was last updated on Sep 25, 2025.