Individual
DIANE E WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDE, RMT
Contact information
Practice address
3105 W ARKANSAS LN, SUITE B-1, ARLINGTON, TX 76016-5721
(817) 798-8977
Mailing address
9109 CHARDIN PARK DR, KELLER, TX 76248-7626
(817) 798-8977
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT04296
TX
Other
Enumeration date
07/18/2006
Last updated
07/08/2007
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