| NPI | 1992550933 |
|---|---|
| Former Legal Business Name | AMANDA WAGNER NUTRITION LLC |
| Entity Type | Organization |
| Authorized Contact | AMANDA WAGNER Owner And Registered Dietitian 312-884-9706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2024-04-23 |