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Organization
AMANDA WAGNER NUTRITION PLLC
Active
Organization
AMANDA WAGNER NUTRITION PLLC
Active
Other names
Amanda Wagner Nutrition LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA WAGNER (OWNER AND REGISTERED DIETITIAN)
(312) 884-9706
Entity
Organization
Contact information
Practice address
4631 N LINCOLN AVE, CHICAGO, IL 60625-2007
(312) 884-9706
Mailing address
4631 N LINCOLN AVE, CHICAGO, IL 60625-2007
(312) 884-9706
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
04/23/2024
Last updated
01/09/2026
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