Wagner, Laura Ella
Wagner, Laura Ella is an sole proprietor health care provider with primary practice located at 14377 Woodlake Dr Suite 111, Chesterfield MO 63017-5735. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Wagner, Laura Ella can be contacted via phone (314) 434-1111.Contact Information
Primary practice address
14377 Woodlake Dr Suite 111
Chesterfield MO 63017-5735
Phone: (314) 434-1111
Fax: (314) 434-1112
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | R8N01 | Missouri |
Profile Details
| NPI number | 1669445060 |
|---|---|
| LBN Legal business name | Wagner, Laura Ella |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 8th, 2006 |
| Last updated | May 24th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669445060 | NPPES |
| Missouri | Other | 18374 | BCBSMO PROVIDER # |
| Missouri | Other | 431895147 | BCBSMO PROVIDER # |
| Missouri | Other | 211386 | BCBSMO PROVIDER # |
| Missouri | Other | 39228V39228 | BCBSMO PROVIDER # |
| Missouri | Other | 4420124 | BCBSMO PROVIDER # |
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