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Individual

OLIVIA WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RDN, LDN

Contact information

Practice address
4555 N LINCOLN AVE, CHICAGO, IL 60625-2102
(773) 273-6734
Mailing address
1455 N SANDBURG TER APT 1207, CHICAGO, IL 60610-1534

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.006320
IL

Other

Enumeration date
09/07/2015
Last updated
09/07/2015
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