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General NPI Number Information
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NPI Number | 1407162670
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Entity Type | Organization
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Legal Business Name | WAGNER AND WOMAN INC.
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 101 S COIT RD SUITE 125
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City | RICHARDSON
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State | TX
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Zip | 75080-5743
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Country | US
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Telephone | 214-340-8566
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Fax | 972-918-0244
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Provider Business Mailing Address
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Address Line | 101 S COIT RD SUITE 125
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City | RICHARDSON
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State | TX
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Zip | 75080-5743
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Country | US
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Telephone | 214-340-8566
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Fax | 972-918-0244
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DIANNA LYNN WAGNER
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Credential | COSMETOLOGY
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Telephone | 214-340-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 717685
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License Number State | TX
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