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1588775357
SUSAN E WAGNER
BEAVERTON, OR
NPI
1588775357
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: OR PA00685)
Enumeration Date
2006-08-31
Last Update Date
2007-07-11
Business Address
-- SUSAN E WAGNER PA-C
4855 SW WESTERN AVE
BEAVERTON, OR 97005-3460
Phone number: 503-643-7565
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Mailing Address
-- SUSAN E WAGNER PA-C
4855 SW WESTERN AVE
BEAVERTON, OR 97005-3460
Phone number: 503-643-7565
Copy
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