| Doctor Name: | MS. SHIRLEY G WAGONER |
| NPI Number: | 1659479723 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | AP60007062 |
| Business Practice Address: | 208 Cedar Creek Terrace Ione, WA - 991390197 |
| Business Phone Number: | 5094423514 |
| Business Fax Number: | 5094423436 |
| Mailing Address: | Po Box 197, IONE |
| State: | WA |
| Postal Code: | 991390197 |
| Phone Number: | 5094423514 |
| Fax Number: | 5094423436 |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 05/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | AP60007062 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |