Individual
SHELLEY RENEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPH, RD, CN
Contact information
Practice address
2209 E 32ND ST, TACOMA, WA 98404-4922
(253) 593-0232
(253) 382-2094
Mailing address
2209 E 32ND ST, TACOMA, WA 98404-4922
(253) 593-0232
(253) 382-2094
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
NU 60064646
WA
133V00000X
Registered Dietitian
Primary
00881196
WA
Other
Enumeration date
01/11/2011
Last updated
01/11/2011
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