Healthcare Provider Details

I. General information

NPI: 1073430070
Provider Name (Legal Business Name): BRIANNA WAGNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA HENRY PA-C

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 ROHRERSTOWN RD STE 200
LANCASTER PA
17603-2230
US

IV. Provider business mailing address

243 W WALNUT ST
LANCASTER PA
17603-2942
US

V. Phone/Fax

Practice location:
  • Phone: 717-431-1770
  • Fax:
Mailing address:
  • Phone: 570-765-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: