Individual
LISA FENDA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
430 WILLET AVE, NAPLES, FL 34108-2104
(216) 409-1727
Mailing address
430 WILLET AVE, NAPLES, FL 34108-2104
(216) 409-1727
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
11012
FL
Other
Enumeration date
01/27/2022
Last updated
01/27/2022
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