Individual
GINA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 HIGH ST, BUFFALO, NY 14203-1126
(716) 859-5600
Mailing address
100 HIGH ST, BUFFALO, NY 14203-1126
(716) 859-5600
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
306669
NY
Other
Enumeration date
10/23/2013
Last updated
10/23/2013
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