Healthcare Provider Details

I. General information

NPI: 1356899363
Provider Name (Legal Business Name): EMILY WAGLER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34509 9TH AVE S STE 303
FEDERAL WAY WA
98003-8709
US

IV. Provider business mailing address

2622 YALE AVE E
SEATTLE WA
98102-3229
US

V. Phone/Fax

Practice location:
  • Phone: 253-942-2280
  • Fax:
Mailing address:
  • Phone: 206-795-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0116030817
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPODI.PO.61051050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: