Individual
TAMMY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
207 W 29TH ST, LUMBERTON, NC 28358-2901
(910) 618-5606
(910) 618-5604
Mailing address
207 W 29TH ST, LUMBERTON, NC 28358-2901
(910) 618-5606
(910) 618-5604
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
125577
NC
Other
Enumeration date
10/27/2012
Last updated
10/27/2012
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