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Individual
JAMES WAGONER
Active
Individual
JAMES WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0211977
DEPT. OF LABOR & INDUSTRY
WA
01
—
6619WA
REGENCE BLUE SHIELD
WA
01
—
8947908
L&I CRIME VICTIMS
WA
Enumeration date
06/10/2006
Last updated
01/16/2009
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