| NPI | 1053720490 |
|---|---|
| Former Name | REBECCA L WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-11827) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006278) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2024-09-13 |