Individual
CASEY MAST WALLNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
5280 NE SHELL WORLD PL, NEWPORT, OR 97365-1246
(541) 579-1823
Mailing address
5280 NE SHELL WORLD PL, NEWPORT, OR 97365-1246
(541) 579-1823
(541) 833-5005
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDD10158382
OR
Other
Enumeration date
04/17/2014
Last updated
09/23/2021
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