Individual
JULIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
4100 W 3RD ST, DAYTON VAMC 120, DAYTON, OH 45428-9000
(937) 268-6511
(937) 262-5967
Mailing address
11781 ZELLER DR, NEW CARLISLE, OH 45344-8917
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD.4812
OH
Other
Enumeration date
08/13/2006
Last updated
07/08/2007
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