Provider Demographics
NPI:1427875434
Name:WAGNER, KAREN M (RD)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 CORY LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-5316
Mailing Address - Country:US
Mailing Address - Phone:219-718-4122
Mailing Address - Fax:
Practice Address - Street 1:1896 CORY LN
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-5316
Practice Address - Country:US
Practice Address - Phone:219-718-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered