Individual
TIFFANY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
2717 E MAIN, PUYALLUP, WA 98372-3165
(253) 279-0424
Mailing address
2717 E MAIN, PUYALLUP, WA 98372-3165
(253) 279-0424
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60449726
WA
Other
Enumeration date
03/26/2014
Last updated
03/26/2014
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