Individual
MS. RANDI LYNN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10 GLENRON ST, CHATTANOOGA, TN 37415-2112
(651) 261-3878
Mailing address
10 GLENRON ST, CHATTANOOGA, TN 37415-2112
(651) 261-3878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4258
TN
363A00000X
Physician Assistant
PA60130
CA
Other
Enumeration date
01/24/2019
Last updated
09/04/2024
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