Active NPI
Michael Hilmar Wagner, R.D., L.D.
- Nutritionist
- Saint Paul, MN
National Provider Identifier
1003085184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- N177
- Practice address
- 2265 Como Ave
Saint Paul, MN 55108-1737 - Phone
- (888) 364-5977
- Fax
- (844) 385-4630
- NPI assigned
- Feb 22, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | N177 | MN | Primary |
Addresses
Primary practice location
2265 Como Ave
Saint Paul, MN 55108-1737
Mailing address
2265 Como Ave
Saint Paul, MN 55108-1737
Phone (651) 645-5323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N177 | MN | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548806400000",
"number": "1003085184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2265 COMO AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551081737",
"telephone_number": "651-645-5323",
"fax_number": "651-647-5135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2265 COMO AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551081737",
"telephone_number": "888-364-5977",
"fax_number": "844-385-4630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "MICHAEL",
"middle_name": "HILMAR",
"credential": "R.D., L.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-22",
"last_updated": "2019-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "MN",
"license": "N177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.