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NPI Code Detail

MEDICARE: PATRICIA SEVERSON-WAGER RD, CDN, CDE

MEDICARE:   PATRICIA  SEVERSON-WAGER  RD, CDN, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian002617NY

General Provider Information

NPI Number : 1801898101
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA SEVERSON-WAGER RD, CDN, CDE
Provider Business Mailing Address
First Line : 1365 WASHINGTON AVE
Second Line : STE 300
City : ALBANY
State : NY
Zip : 12206-1098
Country : US
Telephone Number : 518-489-4704
Fax Number : 518-489-0512
Provider Business Practice Location Address
First Line : 1365 WASHINGTON AVE
Second Line : STE 300
City : ALBANY
State : NY
Zip : 12206-1098
Country : US
Telephone Number : 518-489-4704
Fax Number : 518-489-0512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/08/2007

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Directions to “ PATRICIA SEVERSON-WAGER RD, CDN, CDE” Practice Location

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