Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99074 | TX |
NPI | 1104159474 |
---|---|
Provider Name | Bethany Dolores Wagler |
First Address | Partridge, KS 67566-9030 |
Second Address | Partridge, KS 67566-9030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2009 |
Last Update Date | 17/09/2009 |