Provider Demographics
NPI:1376976894
Name:WAGNER, REBECCA MICHELLE (DVM)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MICHELLE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2340
Mailing Address - Country:US
Mailing Address - Phone:716-901-4399
Mailing Address - Fax:716-854-1313
Practice Address - Street 1:243 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2340
Practice Address - Country:US
Practice Address - Phone:716-901-4399
Practice Address - Fax:716-854-1313
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010427-1174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian