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Individual

DR. CELESTE NICOLE WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
802 GREEN VALLEY RD, SUITE 210, GREENSBORO, NC 27408-7041
(336) 802-2536
(336) 802-2534
Mailing address
1701 WESTCHESTER DR, SUITE 850, HIGH POINT, NC 27262-7008
(336) 802-2536
(336) 802-2534

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
34--008564
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2583520
OH
Enumeration date
02/06/2006
Last updated
01/16/2013
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