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Individual
SCOTT A WAGGONER
Active
Individual
SCOTT A WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.425396
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
1138853
TX
367500000X
Certified Registered Nurse Anesthetist
209.012327
IL
Other
Enumeration date
11/11/2014
Last updated
05/06/2024
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