Individual
DR. KATHRYNE A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
209 LILLY RD NE, OLYMPIA, WA 98506
(360) 413-8250
(360) 413-8830
Mailing address
209 LILLY RD NE, OLYMPIA, WA 98506
(360) 413-8250
(360) 413-8830
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD00029477
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD00029477
MD LICENSE
WA
Enumeration date
11/07/2005
Last updated
03/07/2023
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