| Doctor Name: | ANDREA M WAGNER |
| NPI Number: | 1285963157 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | 200950140NP |
| Business Practice Address: | 180 Atwater St N Monmouth, OR - 973611801 |
| Business Phone Number: | 5036063288 |
| Business Fax Number: | 5036063287 |
| Mailing Address: | 180 Atwater St N, MONMOUTH |
| State: | OR |
| Postal Code: | 973611801 |
| Phone Number: | 5036063288 |
| Fax Number: | 5036063287 |
| NPI Enumeration Date: | 12/23/2009 |
| NPI Last Update Date: | 12/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 200950140NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |