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 |