STEPHANIE MARY WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036170479

License Status

ACTIVE

Business

Title

First Name

STEPHANIE

Middle

MARY

Last Name

WALLACE

Business Name

STEPHANIE MARY WALLACE MD

Original Issue Date

06/04/2024

Effective Date

06/04/2024

Expiration Date

07/31/2026

City

APPLETON

State

Zip

54913

Ever Disciplined

LastModifiedDate

06/04/2024