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Individual

CATHERINE Y.H. WAGONER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
9290 SE SUNNYBROOK BLVD STE 120, CLACKAMAS, OR 97015-6802
(503) 215-2110
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
9839
NV
208000000X
Pediatrics Physician
Primary
MD171324
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002016768
NV
Enumeration date
02/09/2006
Last updated
03/25/2021
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