Doctor Name: | ANNA LAUREN WALLACE |
NPI Number: | 1811318942 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | D1609 |
Business Practice Address: | 102 N. Main St. Mendenhall, MS - 39114 |
Business Phone Number: | 6018472511 |
Business Fax Number: | 6018470931 |
Mailing Address: | 102 N. Main St., MENDENHALL |
State: | MS |
Postal Code: | 39114 |
Phone Number: | 6018472511 |
Fax Number: | 6018470931 |
NPI Enumeration Date: | 12/16/2013 |
NPI Last Update Date: | 12/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | D1609 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |