| NPI | 1205126190 |
|---|---|
| Former Name | MEGAN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105941) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105941) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2023-05-11 |