Individual
MS. SKYE GUSTIN WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3896 BEVERLY AVE NE, BLDG J, STE 40, SALEM, OR 97305-1374
(503) 588-0076
Mailing address
3896 BEVERLY AVE NE, BLDG J, STE 40, SALEM, OR 97305-1374
(503) 588-0076
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/25/2008
Last updated
08/25/2008
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