Doctor Name: | MS. MARIE A WAGNER |
NPI Number: | 1184895070 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 19-3549-004-08 |
Business Practice Address: | 365 Sw Log Dr Port Saint Lucie, FL - 349537501 |
Business Phone Number: | 7727856473 |
Business Fax Number: | 7724080998 |
Mailing Address: | 365 Sw Log Dr, PORT SAINT LUCIE |
State: | FL |
Postal Code: | 349537501 |
Phone Number: | 7727856473 |
Fax Number: | 7724080998 |
NPI Enumeration Date: | 03/18/2008 |
NPI Last Update Date: | 03/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171W00000X |
License Number: | 19-3549-004-08 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Contractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |