| NPI | 1164565545 |
|---|---|
| Former Name | ANDREA S WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: TX 80257) |
| Additional Taxonomies | 231H00000X Audiologist (Licence: MD 01105) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2012-08-13 |