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Individual
CALLAN E WALL
Active
Individual
CALLAN E WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L004679
NC
133V00000X
Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86056016
CDR
—
Enumeration date
07/31/2015
Last updated
09/09/2020
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