Individual
COURTNEY ANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1598 S COUNTY TRL STE 100, EAST GREENWICH, RI 02818
(401) 402-1040
Mailing address
PO BOX 1119, PROVIDENCE, RI 02901-1119
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00835
RI
Other
Enumeration date
10/01/2013
Last updated
08/06/2018
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