Organization
YOUR FRIENDLY DIETITIAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY MAST WALLNER RD, LD (OWNER)
(541) 579-1823
Entity
Organization
Contact information
Practice address
5280 NE SHELL WORLD PL, NEWPORT, OR 97365-1246
(541) 579-1823
(541) 833-5005
Mailing address
5280 NE SHELL WORLD PL, NEWPORT, OR 97365-1246
(541) 579-1823
(541) 833-5005
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
09/23/2021
Last updated
09/23/2021
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