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General NPI Number Information
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NPI Number | 1134949530
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Entity Type | Individual
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Provider Name | KALEN WEHAGEN NDTR
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Gender | Female
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 406 CHINN ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-4339
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Country | US
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Telephone | 707-687-9187
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Fax |
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Provider Business Mailing Address
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Address Line | 159 CALIFORNIA AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-4665
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Country | US
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Telephone | 559-776-9297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number |
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License Number State |
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