Individual
TERESA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
45 SNELLING AVE N, SAINT PAUL, MN 55104-6842
(651) 699-3438
Mailing address
11056 EAGLE VIEW BLVD, WOODBURY, MN 55129-5223
(651) 387-1873
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3574
MN
Other
Enumeration date
08/03/2015
Last updated
08/03/2015
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