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Individual

ANITA WALLAK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD, LDN

Contact information

Practice address
215 W BROAD ST, STATESVILLE, NC 28677-5300
(917) 653-3531
Mailing address
157 NORMANDY RD, MOORESVILLE, NC 28117-8430
(917) 653-3531

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
082017
NC

Other

Enumeration date
12/09/2022
Last updated
12/09/2022
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