Provider Demographics
NPI:1215602156
Name:WALLEN, STACEY GREANIAS (CGC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:GREANIAS
Last Name:WALLEN
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DUMC 2974
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-6327
Mailing Address - Country:US
Mailing Address - Phone:191-966-0196
Mailing Address - Fax:
Practice Address - Street 1:30 DUKE MEDICINE CIR RM 25153
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-3000
Practice Address - Country:US
Practice Address - Phone:919-660-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS