National Provider Identifier
Stacey Marie Wallace
Stacey Marie Wallace is listed in the NPPES registry with a primary specialty of Specialist in Fredonia, NY and a listed phone number of (716) 672-2731.
Profile Overview
- NPI
- 1700149838
- Provider Type
- Individual
- Primary Specialty
- Specialist
- Enumeration Date
- June 22, 2012
- Last Updated
- June 22, 2012
Practice Location
- 75 Chestnut St
- Fredonia, NY 14063-1630
Phone: (716) 672-2731
Mailing Address
- PO Box 311
- Fredonia, NY 14063-0311
Specialties
- Specialist (174400000X)
Full Record
- NPI
- 1700149838
- Entity Type
- Individual
- Last Name
- Wallace
- First Name
- Stacey
- Middle Name
- Marie
- Name Prefix
- MS.
- Mailing Street Address
- PO Box 311
- Mailing City
- Fredonia
- Mailing State
- NY
- Mailing ZIP Code
- 14063-0311
- Mailing Country
- US
- Mailing Phone
- (716) 672-2731
- Practice Street Address
- 75 Chestnut St
- Practice City
- Fredonia
- Practice State
- NY
- Practice ZIP Code
- 14063-1630
- Practice Country
- US
- Practice Phone
- (716) 672-2731
- Enumeration Date
- June 22, 2012
- Last Updated
- June 22, 2012
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Specialist (174400000X)