Wagner, Susan
Wagner, Susan is an individual health care provider with primary practice located at 6846 Buckley Rd , North Syracuse NY 13212-4275. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Wagner, Susan can be contacted via phone (315) 410-6400.Contact Information
Primary practice address
6846 Buckley Rd
North Syracuse NY 13212-4275
Phone: (315) 410-6400
Fax: (315) 410-6410
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | F300531 | New York |
Profile Details
| NPI number | 1205979812 |
|---|---|
| LBN Legal business name | Wagner, Susan |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 14th, 2007 |
| Last updated | Nov 17th, 2014 - about 10 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 | 1205979812 | NPPES |
| New York | MEDICAID | 01969819 |
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