Individual
KIRSTEN E WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6067 PINEY GROVE WAY, GAINESVILLE, VA 20155-6671
(978) 239-4345
Mailing address
6067 PINEY GROVE WAY, GAINESVILLE, VA 20155-6671
(978) 239-4345
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
223761
MA
Other
Enumeration date
05/03/2006
Last updated
04/10/2020
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