Individual
CALLAN E WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
5405 CAROLYN DR, WILMINGTON, NC 28409-5913
(919) 244-8234
(877) 889-2993
Mailing address
1505 MEDICAL CENTER DR, WILMINGTON, NC 28401-7507
(910) 239-3562
(877) 889-2993
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L004679
NC
133V00000X
Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86056016
CDR
—
Enumeration date
07/31/2015
Last updated
09/09/2020
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