Individual
LACEY MICHELLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1201 S MILLER ST, WENATCHEE, WA 98801-3201
(509) 662-1511
Mailing address
1201 S MILLER ST, WENATCHEE, WA 98801-3201
(509) 662-1511
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI61022519
WA
Other
Enumeration date
11/11/2019
Last updated
11/20/2019
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