Individual
GWEN STOOLENWERK WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NTP
Contact information
Practice address
115 SE CRAVEN RD, BEND, OR 97702-1516
(541) 788-4469
Mailing address
115 SE CRAVEN RD, BEND, OR 97702-1516
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
02/02/2012
Last updated
02/02/2012
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