Organization
NUTRIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY WAGNER RD (REGISTERED DIETITIAN)
(630) 776-5461
Entity
Organization
Contact information
Practice address
3530 N RETA AVE APT 2R, CHICAGO, IL 60657-6912
(630) 776-5461
Mailing address
3530 N RETA AVE APT 2R, CHICAGO, IL 60657-6912
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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