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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205979812 NPPES
New York MEDICAID 01969819

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