Provider Demographics
NPI:1649419086
Name:WAGNER, RONALD W JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:W
Last Name:WAGNER
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 G ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2813
Mailing Address - Country:US
Mailing Address - Phone:661-633-1500
Mailing Address - Fax:661-633-2700
Practice Address - Street 1:2635 G ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2813
Practice Address - Country:US
Practice Address - Phone:661-633-1500
Practice Address - Fax:661-633-2700
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566138163W00000X
VA0001210184163W00000X
CANA4061367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse