Individual
MRS. DEBORAH E WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1001 CHESTERFIELD PKWY E, SUITE 101, CHESTERFIELD, MO 63017-2041
(314) 878-3839
(314) 878-6575
Mailing address
1001 CHESTERFIELD PKWY E, SUITE 101, CHESTERFIELD, MO 63017-2041
(314) 878-3839
(314) 878-6575
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2004000667
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00169010
RAILROAD MEDICARE
MO
Enumeration date
05/12/2006
Last updated
08/31/2010
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