Most Relevant Information
Provider Data
| NPI Number: | 1003398256 |
| Provider Name: | GAVIN VAN DE WALLE MS, RD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/04/2018 |
| Last Updated: | 03/14/2020 |
Provider Practice Location
1601 E 77TH ST APT 1428
SIOUX FALLS
SD
571083036
Practice Location Phone/Fax
| Phone: | 6053237222 |
| Fax: |
Provider Mailing Location
PO BOX 210
SIOUX FALLS
SD
571010210
Provider Mailing Phone/Fax
| Phone: | 6053237222 |
| Fax: |