Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 35.067216 | OH |
Y | 207RC0000X | Internist - Cardiovascular Disease | 35.067216 | OH |
NPI | 1831147099 |
---|---|
Provider Name | Dr. Lynne E Wagoner |
First Address | Fairfield, OH 45014-5335 |
Second Address | Fairfield, OH 45014-5335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 25/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0982816 | (05) | OH |
200036340 | (05) | IN |
64936057 | (05) | KY |
F62487 | (02) |