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Individual

EMILY LANIER WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
10101 PARK ROWE AVE, STE, 200, BATON ROUGE, LA 70810
(225) 769-2200
(225) 768-2185
Mailing address
10101 PARK ROWE AVE STE 200, BATON ROUGE, LA 70810-1685
(225) 769-2200
(225) 768-2185

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200757
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2376187
LA
01
PA.200757
LA LICENSE
LA
Enumeration date
09/16/2014
Last updated
06/03/2022
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