Individual
ANNA LAUREN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
102 N. MAIN ST., MENDENHALL, MS 39114
(601) 847-2511
(601) 847-0931
Mailing address
102 N. MAIN ST., MENDENHALL, MS 39114
(601) 847-2511
(601) 847-0931
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1609
MS
Other
Enumeration date
12/16/2013
Last updated
12/26/2013
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