# BETH ELLEN WAGNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1871720482
- **Gender:** F
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 032.0095970 | VT | Yes |
| 207Q00000X | Family Medicine Physician | 5247 | AK | — |
| 208M00000X | Hospitalist Physician | 032.0095970 | VT | — |

## Other

- **Enumeration date:** 06/22/2009
- **Last updated:** 12/04/2014