Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS039409 | PA |
N | 1223P0300X | Periodontist | 10486 | MD |
NPI | 1093020372 |
---|---|
Provider Name | Dr. Rebecca L Wagner |
First Address | Chambersburg, PA 17201-7302 |
Second Address | Chambersburg, PA 17201-7302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2010 |
Last Update Date | 08/06/2020 |