| NPI | 1184160905 |
|---|---|
| Former Legal Business Name | NELL ANN WAGONER, M.D., P.C. |
| Entity Type | Organization |
| Authorized Contact | NICHOLAS D. NEWBURY President 907-586-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AK 107902) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AK MD2531) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: AK NP0168) | |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-07-29 |