Individual
STEPHANIE MARY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 738-2611
Mailing address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 738-2611
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
60446
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
ME
Other
Enumeration date
05/19/2009
Last updated
10/26/2023
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