Individual
MELISSA DALTON WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
34 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9283
(804) 609-0175
(804) 835-5999
Mailing address
34 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9283
(804) 609-0175
(804) 835-5999
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024184994
VA
363LF0000X
Family Nurse Practitioner
3009798
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3009798
APRN LICENSE NUMBER
KY
05
—
7100385910
—
KY
01
—
F0915844
AANP CERTIFICATION NUMBER
—
Enumeration date
09/17/2015
Last updated
12/03/2025
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