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General NPI Number Information
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NPI Number | 1235383811
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Entity Type | Individual
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Provider Name | WANDA S AGNOR
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Gender | Female
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 1565 N LEE HWY
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City | LEXINGTON
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State | VA
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Zip | 24450-3301
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Country | US
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Telephone | 540-464-9663
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Fax | 540-464-9668
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Provider Business Mailing Address
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Address Line | PO BOX 765 1565 NORTH LEE HIGHWAY
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City | LEXINGTON
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State | VA
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Zip | 24450-0765
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Country | US
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Telephone | 540-464-9663
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Fax | 540-464-9668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 79422008
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License Number State | VA
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