Ethan Waller, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86432056 Issued in NC

Practice address

311 S Lasalle St Apt 35a
Durham, NC 27705-3678

Phone

(910) 508-8661

NPI assigned

Jul 24, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1306728936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 S LASALLE ST APT 35A",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053678",
            "telephone_number": "910-508-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 S LASALLE ST APT 35A",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277053678",
            "telephone_number": "910-508-8661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "ETHAN",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "86432056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Arthur Wallace, PA-C
• Shelvey Jean Wallace, LCSW
• Stephen Russell Wallace, DO
• Todd A Wallace, PA-C
• Stacey Greanias Wallen, CGC
• Jesscia Wallis
• Walltown Community Outreach, Inc.
• David Walmer
• Walnut Vision Care NC
• Chaille Anne Walsh, PH.D.

• Registered Dietitian in Durham, NC
• Providers in Durham, NC by specialty
• Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.