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General NPI Number Information
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NPI Number | 1356451660
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Entity Type | Individual
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Provider Name | MICHELE RENEE WALLIN MS, RD, CD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1700 E 38TH ST
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City | MARION
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State | IN
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Zip | 46953-4568
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Country | US
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Telephone | 765-674-3321
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Fax | 765-677-3150
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Provider Business Mailing Address
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Address Line | 9347 W. CO. RD. 50 S.
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City | FARMLAND
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State | IN
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Zip | 47340
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Country | US
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Telephone | 765-468-7170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 706346
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License Number State | IN
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