Active NPI
Renaye Wyganowski, RD, LD
- Registered Dietitian
- White Bear Lake, MN
National Provider Identifier
1386011849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2138
- Practice address
- 1430 Highway 96 E
White Bear Lake, MN 55110-3653 - Phone
- (651) 653-2100
- NPI assigned
- Aug 31, 2015
- Last updated
- Aug 31, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2138 | MN | Primary |
Addresses
Primary practice location
1430 Highway 96 E
White Bear Lake, MN 55110-3653
Mailing address
816 Garceau LN
Vadnais Heights, MN 55127-7145
Phone (651) 238-4558
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 |
|---|---|---|---|
| 2138 | MN | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440979200000",
"number": "1386011849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "816 GARCEAU LN",
"city": "VADNAIS HEIGHTS",
"state": "MN",
"postal_code": "551277145",
"telephone_number": "651-238-4558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 HIGHWAY 96 E",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551103653",
"telephone_number": "651-653-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYGANOWSKI",
"first_name": "RENAYE",
"credential": "RD, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-31",
"last_updated": "2015-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Bear Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.