MARTHA LAINE WAGONER

NORTH CHARLESTON, SC
NPI1497129563
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: SC  19800)
Enumeration Date2015-11-30
Last Update Date2015-11-30
Business Address
-- MARTHA LAINE WAGONER FNP
2102 OTRANTO BLVD
NORTH CHARLESTON, SC 29406-9841
Phone number: 843-569-2225
Mailing Address
-- MARTHA LAINE WAGONER FNP
1010 RIVER HAVEN CIR APT A
CHARLESTON, SC 29412-4121
Phone number: 731-610-6718
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