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Individual

KRIS A WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
112 N 7TH ST, CHAMBERSBURG, PA 17201-1720
(717) 267-7164
(717) 267-7414
Mailing address
601 MEMORY LN, YORK, PA 17402-2231
(717) 851-1405

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN586219
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
050514
MEDICARE GROUP #
PA
01
1007307260035
MEDICAID GROUP #
PA
05
142734113
PA
Enumeration date
05/27/2011
Last updated
10/11/2024
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