Individual
CORAL JANE WAGGONER
Active
Individual
CORAL JANE WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPSGT, RRT,CCSH,MBA
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
PT2013-0001
NM
Other
Enumeration date
04/03/2018
Last updated
04/03/2018
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