Individual
AMANDA LYNN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
158 FAIRHOME AVE, CLYDE, OH 43410-2006
(419) 603-6721
Mailing address
PO BOX 63, CLYDE, OH 43410-0063
(419) 603-6721
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
OH
Other
Enumeration date
10/12/2020
Last updated
10/12/2020
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