Active NPI
Danielle Marie Wagner, RDN, LDN
- Registered Dietitian
- Twin Falls, ID
National Provider Identifier
1780035642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D-927
- Practice address
- 801 Pole Line Rd W
Twin Falls, ID 83301-5810 - Phone
- (208) 814-1000
- NPI assigned
- Jun 22, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-927 | ID | Primary |
Addresses
Primary practice location
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Mailing address
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone (208) 814-1000
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 |
|---|---|---|---|
| D-927 | ID | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466553600000",
"number": "1780035642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 POLE LINE RD W",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015810",
"telephone_number": "208-814-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 POLE LINE RD W",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015810",
"telephone_number": "208-814-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DANIELLE",
"middle_name": "MARIE",
"credential": "RDN, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-22",
"last_updated": "2016-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ID",
"license": "D-927",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.