Individual
DR. NICOLE ANNE STASSEN-WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 ELMWOOD AVE, BOX SURG, ROCHESTER, NY 14642-8410
(585) 275-3376
(585) 276-1992
Mailing address
601 ELMWOOD AVE, BOX SURG, ROCHESTER, NY 14642-8410
(585) 275-3376
(585) 276-1992
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
230009
NY
2086S0127X
Trauma Surgery Physician
Primary
230009
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02497487
—
NY
Enumeration date
06/26/2006
Last updated
07/05/2023
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