Individual
MS. DIANA LYNN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D. L.D.
Contact information
Practice address
8086 S YALE AVE, STE. 184, TULSA, OK 74136-9003
(918) 691-5768
Mailing address
8086 S YALE AVE, STE. 184, TULSA, OK 74136-9003
(918) 691-5768
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
587
OK
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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