Individual
STEPHANIE R WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
5505 27TH AVE NE, APT 2, SEATTLE, WA 98105-5540
(360) 609-2555
Mailing address
5505 27TH AVE NE, APT 2, SEATTLE, WA 98105-5540
(360) 609-2555
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1039941
WA
Other
Enumeration date
02/03/2016
Last updated
02/03/2016
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