Individual
MS. MARY ELISE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSRD/LD
Contact information
Practice address
6705 HERITAGE PKWY STE 104, ROCKWALL, TX 75087-8729
(972) 412-7700
Mailing address
PO BOX 127, ROCKWALL, TX 75087-0127
(972) 412-7700
(972) 412-7710
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT03189
TX
Other
Enumeration date
12/15/2016
Last updated
08/12/2021
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