| Doctor Name: | TERESA MOORE WAGNER |
| NPI Number: | 1063572717 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, CDE |
| License Number: | 30547 |
| Business Practice Address: | 150 Duncan Road Buckeye, WV - 249249037 |
| Business Phone Number: | 3047997400 |
| Business Fax Number: | 3047992276 |
| Mailing Address: | 150 Duncan Road, BUCKEYE |
| State: | WV |
| Postal Code: | 249249037 |
| Phone Number: | 3047997400 |
| Fax Number: | 3047992276 |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 09/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | 30547 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WV |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |