Individual
DIANNE B WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 SAS CAMPUS DR, CARY, NC 27513-2414
(919) 531-9173
(919) 654-3800
Mailing address
100 SAS CAMPUS DR, CARY, NC 27513-2414
(919) 531-9173
(919) 654-3800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200928
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200928
NP LICENSE NO
NC
Enumeration date
10/20/2006
Last updated
07/08/2007
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