Provider Demographics
NPI:1063299881
Name:WAGNER, TAMMY LYNN (PHD, RDN)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LYNN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 CHIMNEY CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:VA
Mailing Address - Zip Code:22645-2177
Mailing Address - Country:US
Mailing Address - Phone:540-246-7099
Mailing Address - Fax:
Practice Address - Street 1:757 CHIMNEY CIR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:VA
Practice Address - Zip Code:22645-2177
Practice Address - Country:US
Practice Address - Phone:540-246-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty