Individual
MARY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
100 HIGH ST, BUFFALO, NY 14203-1126
(716) 859-2220
(716) 859-1521
Mailing address
406 LINWOOD AVE REAR, BUFFALO, NY 14209-1629
(716) 886-0444
(716) 885-7070
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
287759
NY
Other
Enumeration date
07/24/2006
Last updated
07/08/2007
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