Individual
KELSEY RUTH WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5915 ORCHARD ST W, TACOMA, WA 98467-3824
(253) 414-7461
Mailing address
9005 120TH STREET CT E, PUYALLUP, WA 98373-7908
(253) 378-9216
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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