Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MB-0600019 | CA |
NPI | 1598990798 |
---|---|
Provider Name | Carrie I. Wager |
First Address | Stockton, CA 95204-4413 |
Second Address | Stockton, CA 95209-4703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2009 |
Last Update Date | 19/05/2009 |