Individual
CATHERINE B WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
7640 E PARHAM RD, HENRICO, VA 23294-4300
(804) 285-4763
(804) 288-8946
Mailing address
PO BOX 17978, RICHMOND, VA 23226-7978
(804) 288-4453
(804) 288-1621
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024166044
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010086051
—
VA
Enumeration date
10/10/2005
Last updated
07/23/2012
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