Individual
ANGIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NC
Contact information
Practice address
233 EASTERLY PKWY, 104, STATE COLLEGE, PA 16801-6300
(814) 234-0785
Mailing address
233 EASTERLY PKWY, 104, STATE COLLEGE, PA 16801-6300
(814) 234-0785
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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