TYLER R VAN WAGENEN

ONTARIO, OR
NPI1700656352
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
Enumeration Date2024-01-04
Last Update Date2024-07-30
Business Address
Mr. TYLER R VAN WAGENEN PA
2327 SW 4TH AVE
ONTARIO, OR 97914-1851
Phone number: 541-889-2340
Mailing Address
Mr. TYLER R VAN WAGENEN PA
1441 NE 10TH AVE
PAYETTE, ID 83661-5420
Phone number: 208-642-9376
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