Organization
REX D WAGGONER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REX D WAGGONER CRNA (PRESIDENT)
(479) 751-6352
Entity
Organization
Contact information
Practice address
609 W MAPLE AVE, SPRINGDALE, AR 72764-5335
(479) 751-5711
Mailing address
PO BOX 580, SPRINGDALE, AR 72765-0580
(479) 751-6352
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C00272
AR
Other
Enumeration date
04/16/2007
Last updated
08/22/2020
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