Individual
SANDRA R WYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN
Contact information
Practice address
2900 W ANDERSON LN STE C-200354, AUSTIN, TX 78757-1102
(512) 643-3761
(737) 282-0615
Mailing address
912 BANYON ST UNIT B, AUSTIN, TX 78757-1506
(512) 878-0464
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
DT82734
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DT82734
STATE LICENSE
TX
01
—
LD-0737
STATE LICENSE
NM
01
—
LD-D-000996
STATE LICENSE
OR
Enumeration date
11/08/2011
Last updated
06/19/2022
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