Individual
ZACKERY ROBERT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2323 JENSEN ST, ENUMCLAW, WA 98022-3605
(360) 825-2541
Mailing address
PO BOX 1287, BUCKLEY, WA 98321-1287
(360) 761-9516
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
NA61270089
WA
Other
Enumeration date
04/17/2023
Last updated
04/17/2023
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