Individual
MS. AMANDA DIANE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
9040 JACKSON AVENUE, TACOMA, WA 98431-7311
(352) 968-1631
Mailing address
5405 TUCKERMAN LN APT 425, ROCKVILLE, MD 20852-7311
(301) 400-2702
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
06/18/2013
Last updated
08/26/2019
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