Individual
MRS. STACY L. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LD
Contact information
Practice address
110 MEMORIAL HOSPITAL DR., HUNTSVILLE, TX 77340
(936) 291-4525
Mailing address
PO BOX 6175, HUNTSVILLE, TX 77342-6175
(936) 291-1153
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT04058
TX
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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