Mary Terese Wallace
Dietitian, Registered in Port Angeles, WA. Individual provider (NPI-1).
NPI number1982156766
StatusActive
Last updated in NPPESApr 11, 2023
Details
- NPI
- 1982156766
- Entity type
- Individual (NPI-1)
- Name
- Mary Terese Wallace
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 27, 2016
- Certification date
- Apr 5, 2023
- Last updated
- Apr 11, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | DI 60685427 | WA | Yes |
Other names
- Terese Wallace (Professional Name)
Practice location
939 Caroline StPort Angeles, WA 98362-3997
Phone 360-417-7125 · Fax 360-417-7188
Mailing address
700 BroadwaySeattle, WA 98122-4302
Phone 206-720-3734 · Fax 206-292-2163
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