Individual
ALYSE C WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2125 STATE ST STE 1, NEW ALBANY, IN 47150-4987
(812) 949-7151
(812) 949-7191
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(812) 273-5392
(812) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002830A
IN
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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