Individual
TERESA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1560 N 115TH ST STE G10, SEATTLE, WA 98133-8414
(206) 368-1558
Mailing address
1560 N 115TH ST STE G10, SEATTLE, WA 98133-8414
(206) 368-1558
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD00037705
WA
208M00000X
Hospitalist Physician
37705
WA
Other
Enumeration date
09/16/2006
Last updated
03/29/2012
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