MEDICARE: MRS. LAUREN MARIE WAGNER R.D., #981448

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
1	133V00000X	Registered Dietitian	981448	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	981448	OTHER	NJ	REGISTERED DIETITIAN CREDENTIALED BY THE COMMISSION ON DIETETIC REGISTRATION

General Provider Information

NPI Number	:	1942444922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN MARIE WAGNER R.D., #981448

Provider Business Mailing Address
First Line	:	2601 S LEMAY AVE UNIT 7
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2298
Country	:	US
Telephone Number	:	518-852-4977
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 S LEMAY AVE UNIT 7
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2298
Country	:	US
Telephone Number	:	518-852-4977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	09/12/2025

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