Individual
MS. SARAH C WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
280 S 1ST AVE, MILL CITY, OR 97360-2324
(503) 897-4100
(503) 897-2673
Mailing address
PO BOX 47, MILL CITY, OR 97360-0047
(503) 897-4100
(503) 897-2673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3110
AZ
363A00000X
Physician Assistant
99
MT
363A00000X
Physician Assistant
Primary
PA161499
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500657211
—
OR
01
—
R01271179
RAILROAD MEDICARE - PH&S
OR
Enumeration date
10/05/2006
Last updated
05/18/2021
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