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General NPI Number Information
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NPI Number | 1356555791
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Entity Type | Organization
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Legal Business Name | DUKE E. WAGNER,PH.D.,INC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 970 N KALAHEO AVE A204
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City | KAILUA
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State | HI
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Zip | 96734-1801
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Country | US
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Telephone | 808-254-5468
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Fax | 808-262-4437
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Provider Business Mailing Address
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Address Line | PO BOX 2192
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City | PEARL CITY
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State | HI
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Zip | 96782-9192
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Country | US
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Telephone | 808-254-5468
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Fax | 808-262-4437
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DUKE ELVIN WAGNER
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Credential | PH.D.
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Telephone | 808-254-5468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY298
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License Number State | HI
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