Individual
LACEY WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
713 W OAK STREET, SUNDANCE, WY 82729
(307) 283-3501
Mailing address
PO BOX 517, SUNDANCE, WY 82729-0517
(307) 283-3501
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
0410
SD
133V00000X
Registered Dietitian
Primary
211
WY
Other
Enumeration date
08/02/2011
Last updated
12/20/2018
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