Individual
HAILEY LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1152 KINGS HIGHWAY CUTOFF, FAIRFIELD, CT 06824-5271
(203) 785-2579
Mailing address
11 EDGAR AVE, BROOKHAVEN, NY 11719-9605
(631) 905-1563
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6953
CT
363A00000X
Physician Assistant
—
—
Other
Enumeration date
10/11/2024
Last updated
02/05/2025
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