Individual
ALYSSA ROSE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
353 DEADMOND FERRY RD, SPRINGFIELD, OR 97477-9406
(541) 337-4970
Mailing address
353 DEADMOND FERRY RD, SPRINGFIELD, OR 97477-9406
(541) 337-4970
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
201140420RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L-144285
IBLCE
OR
Enumeration date
10/23/2018
Last updated
10/23/2018
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