Provider Demographics
NPI:1942444922
Name:WAGNER, LAUREN MARIE (RD, #981448)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RD, #981448
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CENTRAL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8340
Mailing Address - Country:US
Mailing Address - Phone:609-926-5000
Mailing Address - Fax:609-926-2020
Practice Address - Street 1:301 CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8340
Practice Address - Country:US
Practice Address - Phone:609-926-5000
Practice Address - Fax:609-926-2020
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ981448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ981448OtherREGISTERED DIETITIAN CREDENTIALED BY THE COMMISSION ON DIETETIC REGISTRATION