Individual
MRS. CANDICE ASHLEY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
80 WILLOWBROOK CT, STATEN ISLAND, NY 10302-2402
(718) 981-0502
Mailing address
17 TIMOTHY LN, TINTON FALLS, NJ 07724-3133
(347) 703-9010
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
717701
NY
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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