Individual
MARTHA E WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
923 BROAD ST, DURHAM, NC 27705-4141
(919) 475-9983
Mailing address
410 CYPRESS CREEK CIR, OLDSMAR, FL 34677-2009
(919) 475-9983
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
204481
NC
Other
Enumeration date
02/27/2007
Last updated
07/08/2007
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