Individual provider · Type 1 NPI

Charlesetta Wallace, APRN, CNM

Advanced Practice Midwife · Bloomington, IL

NPI number 1114896032 Active

Practice location

2111 E Oakland Ave Ste B
Bloomington, IL 61701-5783

Call (309) 808-3068 Map

Mailing address

5100 W Bradford Woods Cir Apt T
Peoria, IL 61615-8978

Specialties and licenses

TaxonomyCodeLicense
Advanced Practice Midwife Primary 367A00000X209033647 (IL)

Advanced Practice Midwife: Advanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; and family planning services, including preconception care. Midwives also provide primary care for individuals from adolescence throughout the lifespan as well as care for the healthy newborn during the first 28 days of life. Midwives p…

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About NPI 1114896032

Charlesetta Wallace, APRN, CNM's National Provider Identifier is 1114896032, issued on Oct 30, 2025. The primary taxonomy on file is Advanced Practice Midwife (367A00000X), and the practice location is in Bloomington, IL. The record was last updated on Oct 30, 2025.