Individual
SHANIN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25072 NORTHWESTERN PIKE, ROMNEY, WV 26757-5039
(304) 822-2177
(304) 822-4977
Mailing address
233 ROSEANNA ST, WILEY FORD, WV 26767-8032
(301) 707-4846
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
22584
WV
Other
Enumeration date
07/06/2022
Last updated
07/06/2022
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