Individual
MS. LAURA BETH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14 DEERWOOD DR, CLARK, NJ 07066-2817
(732) 574-2481
Mailing address
14 DEERWOOD DR, CLARK, NJ 07066-2817
(732) 574-2481
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015966
NY
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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