Individual
DALLAS WAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
87 WASHINGTON ST, RENSSELAER, NY 12144-2613
(518) 449-1142
Mailing address
POX 148, RENSSELAER, NY 12144
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
293175
NY
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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