Individual
MS. FIDELA WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
12530 OUT OF THE WAY PLACE, AUBURN, CA 95603-2927
(530) 305-8048
Mailing address
12530 OUT OF THE WAY PLACE, AUBURN, CA 95603-2927
(530) 305-8048
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
352490
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
352490
REGISTERED NURSE
CA
01
—
RVN003000
PROVIDER NUMBER
CA
Enumeration date
05/03/2007
Last updated
07/08/2007
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