Healthcare Provider Details

I. General information

NPI: 1902055957
Provider Name (Legal Business Name): SHERYL ANN WAGNER N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 NE 78TH ST
VANCOUVER WA
98665-9635
US

IV. Provider business mailing address

1612 NE 78TH ST
VANCOUVER WA
98665-9635
US

V. Phone/Fax

Practice location:
  • Phone: 360-433-2727
  • Fax: 503-200-1420
Mailing address:
  • Phone: 360-433-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60024776
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberNT60024776
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: