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Individual
SUZANNE WAGNER
Active
Individual
SUZANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1120402
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100389910
—
KY
Enumeration date
08/29/2014
Last updated
02/18/2022
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