Provider Demographics
NPI:1033393269
Name:WAGNER, JULIE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:M
Last Name:WAGNER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3471 FIFTH AVENUE
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3221
Mailing Address - Country:US
Mailing Address - Phone:412-692-2478
Mailing Address - Fax:412-692-2486
Practice Address - Street 1:3471 5TH AVENUE
Practice Address - Street 2:1110
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3221
Practice Address - Country:US
Practice Address - Phone:412-692-2478
Practice Address - Fax:412-692-2486
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA-003071-L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical