Individual
GEORGIA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA,RD,CD
Contact information
Practice address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
(765) 825-5131
(765) 827-7863
Mailing address
1941 VIRGINIA AVE, CONNERSVILLE, IN 47331-2833
(765) 825-5131
(765) 827-7863
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37000770A
IN
Other
Enumeration date
05/14/2014
Last updated
05/14/2014
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