Individual
KAYLA ROSE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3119
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10050503
SERVSAFE
MN
01
—
3119
BOARD OF DIETETICS & NUTRITION PRACTICE
MN
01
—
86007314
ACADEMY OF NUTRITION AND DIETETICS VERIFICATION
MN
01
—
XE20265137
NATIONAL REGISTRY OF FOOD SAFETY CERTIFIED FOOD SAFETY MANAGER
—
Enumeration date
06/21/2012
Last updated
08/21/2014
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