Individual
RUTH WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1241 SHAWHAN RD, MORROW, OH 45152-9695
(513) 865-5204
Mailing address
PO BOX 632572, CINCINNATI, OH 45263-2572
(513) 865-5204
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
243431
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
243431
LICENSE
OH
Enumeration date
12/07/2009
Last updated
06/28/2013
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