Individual
GAVIN VAN DE WALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, RD
Contact information
Practice address
1601 E 77TH ST APT 1428, SIOUX FALLS, SD 57108-3036
(605) 323-7222
Mailing address
PO BOX 210, SIOUX FALLS, SD 57101-0210
(605) 323-7222
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
09/04/2018
Last updated
03/14/2020
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