Active NPI
Laura Wagner, MS, RD
- Registered Dietitian
- Pontiac, MI
National Provider Identifier
1962254888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86045766
- Practice address
- 44555 Woodward Ave Ste 105
Pontiac, MI 48341-5032 - Phone
- (248) 885-3515
- NPI assigned
- Apr 3, 2024
- 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 | 86045766 | MI | Primary |
Addresses
Primary practice location
44555 Woodward Ave Ste 105
Pontiac, MI 48341-5032
Mailing address
24 Frank Lloyd Wright Dr Ste J2000
Ann Arbor, MI 48105-9484
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86045766 | MI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1962254888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 FRANK LLOYD WRIGHT DR STE J2000",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481059484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44555 WOODWARD AVE STE 105",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483415032",
"telephone_number": "248-885-3515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LAURA",
"credential": "MS, RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-03",
"last_updated": "2024-04-08",
"certification_date": "2024-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "86045766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.