Individual
MARGARET WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
14551 JUDICIAL RD STE 100, BURNSVILLE, MN 55306-4991
(763) 568-2419
Mailing address
5941 143RD CIR NW, RAMSEY, MN 55303-5617
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86083016
—
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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