| Provider / Organization | NPI | Date Certified |
|---|---|---|
| EMILY WALLACE | 1437732062 | 2021-05-02 |
Emily Wallace is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1437732062. Registration indicates Emily Wallace is a provider of services with a specialization in Dietary & Nutritional Service Providers, Dietitian, Registered (Dietitian, Registered: Nutrition, Pediatric, ) (Dietitian, Registered Nutrition, Pediatric, Dietary & Nutritional Service Providers) (Dietitian, Registered, ) (Dietary & Nutritional Service Providers, Dietitian, Registered) (Dietitian, Registered, ) (All Other Specialties & Provider Types, ) (Dietitian, Registered, Dietary & Nutritional Service Providers)
| Entity Type | Individual |
| Provider Name | Emily Wallace RDN |
| Practice Office Address | 3500 CIVIC CENTER BLVD PHILADELPHIA, PA US |
| Practice Office Telephone | 2152859048 |
| Mailing Address | 1814 PINE ST APT 1R PHILADELPHIA, PA 191036645 US |
| Business Telephone | 2152859048 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 1814 Pine St Apt 1R | Philadelphia, PA 191036645 | 2152859048 |
| Code | Practice | License No State |
|---|---|---|
| 133VN1004X | Dietary & Nutritional Service Providers Dietitian, Registered Dietitian, Registered: Nutrition, Pediatric Dietitian, Registered Nutrition, Pediatric Dietary & Nutritional Service Providers Dietitian, Registered | |
| 133V00000X PRIMARY | Dietary & Nutritional Service Providers Dietitian, Registered Dietitian, Registered All Other Specialties & Provider Types Dietitian, Registered Dietary & Nutritional Service Providers | 86098606
PA |