Individual
MS. SHELLY WAGAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1829 NE ALBERTA ST, SUITE A, PORTLAND, OR 97211-5879
(503) 249-9300
Mailing address
1829 NE ALBERTA ST, SUITE A, PORTLAND, OR 97211-5879
(503) 249-9300
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC170862
OR
Other
Enumeration date
01/29/2015
Last updated
01/29/2015
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