Individual
EMILY BETH WAGGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, CRNA
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2019039179
MO
367500000X
Certified Registered Nurse Anesthetist
2020013616
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
209025439
IL
Other
Enumeration date
05/04/2020
Last updated
12/09/2022
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