Jeanne M Wallace, PHD

NPI #1285911032 in North Logan, Utah

Provider Information

NPI Number: 1285911032
Entity Type: Individual
Name: Jeanne M Wallace, PHD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Nutritionist
Credential: PHD
Enumeration Date: Nov 8, 2011
Last Updated: Nov 8, 2011

Practice Location

Address: 1697 E 3450 N
City: North Logan
State: Utah
ZIP Code: 84341-8310
Phone: (435) 563-0053

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nutritionist	133N00000X	Primary

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