Individual
AMANDA MITCHELL WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
207 BULIFANTS BLVD STE C, WILLIAMSBURG, VA 23188-5732
(757) 622-6315
(757) 622-7022
Mailing address
6160 KEMPSVILLE CIR, SUITE 200 A, NORFOLK, VA 23502-3933
(757) 622-6315
(757) 625-6940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002368
VA
Other
Enumeration date
10/17/2006
Last updated
06/24/2024
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