Provider Demographics
NPI:1831482942
Name:WENGER, CARIE LYNN (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CARIE
Middle Name:LYNN
Last Name:WENGER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:CARIE
Other - Middle Name:LYNN
Other - Last Name:WISHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4205 MCAULEY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8391
Mailing Address - Country:US
Mailing Address - Phone:405-543-9525
Mailing Address - Fax:
Practice Address - Street 1:4205 MCAULEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8391
Practice Address - Country:US
Practice Address - Phone:405-543-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered