Individual
MRS. CATHERINE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 ROBERTS DR, JACKSONVILLE BEACH, FL 32250-3253
(904) 477-9882
Mailing address
709 4TH AVE N, JACKSONVILLE BEACH, FL 32250-4527
(904) 477-9882
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND4727
FL
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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