Organization
AMANDA WAGNER NUTRITION PLLC
Active
Other names
Amanda Wagner Nutrition LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA WAGNER (OWNER AND REGISTERED DIETITIAN)
(312) 884-9706
Entity
Organization
Contact information
Practice address
4631 N LINCOLN AVE, CHICAGO, IL 60625-2007
(312) 884-9706
Mailing address
4631 N LINCOLN AVE, CHICAGO, IL 60625-2007
(312) 884-9706
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
04/23/2024
Last updated
01/09/2026
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