Individual
JEAN D. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
411 LINCOLN ST, NEENAH, WI 54956-2753
(920) 727-4299
Mailing address
411 LINCOLN ST, NEENAH, WI 54956-2753
(920) 727-4299
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
641-029
WI
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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