Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD00037705 | WA |
NPI | 1033215181 |
---|---|
Provider Name | Teresa Wagner |
First Address | Seattle, WA 98133-8414 |
Second Address | Seattle, WA 98133-8414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 29/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C04330 | (02) |