Individual
SAMANTHA WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
156 POPLAR LICK LN, PENNSBORO, WV 26415-6252
(304) 483-4796
Mailing address
156 POPLAR LICK LN, PENNSBORO, WV 26415-6252
(304) 483-4796
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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