Provider Demographics
NPI:1902055957
Name:WAGNER, SHERYL ANN (ND)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:ANN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 NE 78TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9635
Mailing Address - Country:US
Mailing Address - Phone:360-433-2727
Mailing Address - Fax:
Practice Address - Street 1:1612 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9635
Practice Address - Country:US
Practice Address - Phone:360-433-2727
Practice Address - Fax:503-200-1420
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60024776208D00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice