Individual
MRS. MARIE WALLA FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
100 PARK ST, GLENS FALLS, NY 12801-4413
(518) 926-2612
(518) 926-6727
Mailing address
80 MCCORMACK DR, LAKE GEORGE, NY 12845-3425
(518) 798-8032
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
001471-1
NY
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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