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 |