| Doctor Name: | SANDRA WAGNER |
| NPI Number: | 1104155571 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | 10889 |
| Business Practice Address: | 9050 N Church Dr Parma Heights, OH - 441304701 |
| Business Phone Number: | 4402920226 |
| Business Fax Number: | 4402920225 |
| Mailing Address: | 20455 Lorain Rd, Ste T01 FAIRVIEW PARK |
| State: | OH |
| Postal Code: | 441263494 |
| Phone Number: | 4407994224 |
| Fax Number: | 4407994228 |
| NPI Enumeration Date: | 12/15/2009 |
| NPI Last Update Date: | 01/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 10889 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |