Individual
MR. GARY L. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
16010 E INDIANA AVE, SPOKANE VALLEY, WA 99216-1813
(509) 928-8040
Mailing address
7058 N MADELLAINE DR, COEUR D ALENE, ID 83815-7108
(253) 334-3886
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN00094715
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0124415
L & I
WA
01
—
100378
L & I
WA
05
—
9610098
—
WA
01
—
WA5338
REGENCE
WA
Enumeration date
11/29/2006
Last updated
02/13/2024
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