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Individual
STACY WAGNER
Active
Individual
STACY WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
926900
CA
133VN1101X
Gerontological Nutrition Registered Dietitian
936900
CA
Other
Enumeration date
09/13/2025
Last updated
09/13/2025
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