Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 9501686 | NC |
NPI | 1023097516 |
---|---|
Provider Name | Miss Jill M Wagner |
First Address | High Point, NC 27262-7008 |
Second Address | High Point, NC 27262-4341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 07/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8911473 | (05) | NC |
G82990 | (02) | NC |