| Doctor Name: | MS. EDYE LYNN WAGNER |
| NPI Number: | 1346416740 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, LDN |
| License Number: | 164000949 |
| Business Practice Address: | 660 N Westmoreland Rd Lake Forest, IL - 600451659 |
| Business Phone Number: | 8472345600 |
| Business Fax Number: | 8475357851 |
| Mailing Address: | 660 N Westmoreland Rd, LAKE FOREST |
| State: | IL |
| Postal Code: | 600451659 |
| Phone Number: | 8472345600 |
| Fax Number: | 8475357851 |
| NPI Enumeration Date: | 05/06/2008 |
| NPI Last Update Date: | 05/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 164000949 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |