Individual
MRS. MARLO WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,CDE
Contact information
Practice address
9322 E 41ST ST, TULSA, OK 74145-3721
(918) 764-7209
Mailing address
5442 E 109TH PL, TULSA, OK 74137-7247
(918) 296-3910
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
809909
OK
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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