Individual
ANDREW WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 459-4349
Mailing address
2311 E TRENTON AVE, FRESNO, CA 93720-3927
(559) 321-3441
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
779455
CA
Other
Enumeration date
07/12/2018
Last updated
07/12/2018
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