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General NPI Number Information
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NPI Number | 1366061665
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Entity Type | Individual
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Provider Name | ANDREA HESS WAGNER MD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1713 SW H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76502-1836
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Country | US
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Telephone | 254-771-8100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone | 800-994-0371
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | V0214
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License Number State | TX
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