Organization
ERNESTINE WAGNER, PA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ERNESTINE WAGNER (OWNER)
(276) 979-1309
Entity
Organization
Contact information
Practice address
29306 G C PEERY HIGHWAY, NORTH TAZEWELL, VA 24630-9192
(276) 979-1309
(188) 851-0261
Mailing address
29306 G C PEERY HIGHWAY, NORTH TAZEWELL, VA 24630-9192
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001577
VA
Other
Enumeration date
12/23/2008
Last updated
12/23/2008
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