Celeste Nicole Wallace, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

34--008564 Issued in OH

Practice address

802 Green Valley Rd
Suite 210
Greensboro, NC 27408-7041

Phone

(336) 802-2536

Fax

(336) 802-2534

NPI assigned

Feb 6, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wake Forest Health Network LLC

  • Family Medicine Physician
  • Granite Falls, NC
  • NPI 1770858938
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358294400000",
    "number": "1740252576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 WESTCHESTER DR",
            "address_2": "SUITE 850",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627008",
            "telephone_number": "336-802-2536",
            "fax_number": "336-802-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 GREEN VALLEY RD",
            "address_2": "SUITE 210",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087041",
            "telephone_number": "336-802-2536",
            "fax_number": "336-802-2534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CELESTE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-06",
        "last_updated": "2013-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34--008564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2583520",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Konette Kendall Wall, CRNA
• Martha Elizabeth Wall, ATC
• Ryshee Wall, LCSWA
• Thomas Craven Wall, M.D.
• Catherine Lauren Wallace, D.O.
• Erica Renee Wallace, D.O.
• Imani Wallace
• Sophia Pina Wallace
• Stephanie Dawn Wallace, SW
• Tiffany Wallace, DNP

• Pediatrics Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.