Individual
JOHANNE MAE WAGGY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3251 OLD LEE HWY STE 200, FAIRFAX, VA 22030-1504
(877) 868-4827
Mailing address
9554 SUNNYSLOPE DR, MANASSAS, VA 20112-2735
(703) 475-9591
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
0024177230
VA
Other
Enumeration date
06/06/2019
Last updated
03/31/2021
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