Individual
MRS. KAREN KAYE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
7904 NE 6TH AVE, SUITE C, VANCOUVER, WA 98665-8150
(360) 690-4114
Mailing address
1309 NE 103RD CT, VANCOUVER, WA 98664-4307
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00015471
WA
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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