Individual
DEAN S WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 GARFIELD AVE, PARKERSBURG, WV 26101-5340
(304) 422-3904
Mailing address
427 QUAIL POINTE DR, FLORENCE, SC 29501-7739
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
74549
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
APN3448
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN 1681
—
SC
Enumeration date
02/11/2008
Last updated
06/13/2011
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