Individual
ETHAN O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
12304 WILLOW WOODS DR, FREDERICKSBURG, VA 22407-6659
(540) 718-8961
Mailing address
12304 WILLOW WOODS DR, FREDERICKSBURG, VA 22407-6659
(540) 718-8961
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
10/28/2021
Last updated
10/28/2021
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