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Individual

MS. MAUREEN PATRICIA WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.D.

Contact information

Practice address
753 VIRGINIA ST, DUNEDIN, FL 34698-6615
(727) 734-6888
(727) 734-6898
Mailing address
PO BOX 1698, CLEARWATER, FL 33757-1698
(727) 532-0002

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND4693
FL

Other

Enumeration date
06/02/2006
Last updated
08/06/2010
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