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General NPI Number Information
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NPI Number | 1992833297
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Entity Type | Individual
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Provider Name | DANIELLE CARRIE WAGNER LCGC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 1 S PENN SQ
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City | PHILADELPHIA
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State | PA
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Zip | 19107-3400
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Country | US
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Telephone | 215-873-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 6 CONTINENTAL LN
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City | MARLTON
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State | NJ
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Zip | 08053-4606
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Country | US
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Telephone | 609-206-0210
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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 | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | 2002350
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License Number State | PA
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