Individual
ETHAN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD, LDN
Contact information
Practice address
311 S LASALLE ST APT 35A, DURHAM, NC 27705-3678
(910) 508-8661
Mailing address
311 S LASALLE ST APT 35A, DURHAM, NC 27705-3678
(910) 508-8661
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86432056
NC
Other
Enumeration date
07/24/2025
Last updated
07/24/2025
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