Individual
CAITLIN RUTH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
501 MARKET ST, LEWISBURG, PA 17837-3002
(570) 524-0900
(570) 524-0910
Mailing address
1322 QUEEN ST, NORTHUMBERLAND, PA 17857-8638
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
PN287149
PA
Other
Enumeration date
01/16/2012
Last updated
01/16/2012
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