Individual
TERESA MOORE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
150 DUNCAN ROAD, BUCKEYE, WV 24924-9037
(304) 799-7400
(304) 799-2276
Mailing address
150 DUNCAN ROAD, BUCKEYE, WV 24924-9037
(304) 799-7400
(304) 799-2276
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
30547
WV
164W00000X
Licensed Practical Nurse
Primary
30547
WV
Other
Enumeration date
12/11/2006
Last updated
09/23/2015
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