Individual
SUZANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1200 BRECKENRIDGE ST, OWENSBORO, KY 42303-1089
(270) 683-8672
(270) 685-8233
Mailing address
1200 BRECKENRIDGE ST, OWENSBORO, KY 42303-1089
(270) 684-0028
(270) 683-8672
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1120402
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100389910
—
KY
Enumeration date
08/29/2014
Last updated
02/18/2022
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