Individual
STEPHANIE L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LDN
Contact information
Practice address
10400 HALIGUS RD, HUNTLEY, IL 60142-9553
(224) 654-0389
Mailing address
8983 NICOLE PL, BELVIDERE, IL 61008-8530
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164006890
IL
Other
Enumeration date
03/23/2017
Last updated
02/19/2020
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