Individual
BETH A. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
833 CHESTNUT STREET, SUITE 301, PHILADELPHIA, PA 19107-4405
(215) 955-7190
(215) 923-9186
Mailing address
833 CHESTNUT STREET, SUITE 301, PHILADELPHIA, PA 19107-4405
(215) 955-7190
(215) 923-9186
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP008597
PA
Other
Enumeration date
04/18/2006
Last updated
04/06/2011
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