Individual
MEREDITH G WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LRD
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4111
(701) 234-4130
Mailing address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4111
(701) 234-4130
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
731
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55103
—
ND
Enumeration date
09/19/2007
Last updated
12/27/2007
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