Individual
PAMELA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-1687
Mailing address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 144158-7
MN
Other
Enumeration date
10/17/2007
Last updated
01/02/2014
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