Provider Demographics
NPI:1275124430
Name:WAGES, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WAGES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 LAUREL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659
Mailing Address - Country:US
Mailing Address - Phone:336-414-3668
Mailing Address - Fax:
Practice Address - Street 1:427 LAUREL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-414-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant