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Individual

HANNA WAGONER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6000
Mailing address
2504 S BARCLIFF AVE, SPRINGFIELD, MO 65804-3533
(479) 586-8246

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86290703
MO

Other

Enumeration date
07/22/2022
Last updated
07/25/2022
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