| NPI | 1508815820 |
|---|---|
| Former Name | SARAH T WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1733) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 1733-023) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 1733-023) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2020-11-23 |