Individual
SARA JAGELS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 S 320TH ST STE A, FEDERAL WAY, WA 98003-4691
(904) 273-2717
Mailing address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 9103621
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2141807
—
WA
Enumeration date
01/04/2009
Last updated
06/03/2020
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