Individual
IRENE WAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1416 N BERRY RD, SAINT LOUIS, MO 63119-1204
(314) 368-9108
Mailing address
1416 N BERRY RD, SAINT LOUIS, MO 63119-1204
(314) 368-9108
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2010030876
MO
Other
Enumeration date
03/13/2012
Last updated
03/13/2012
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