Provider Demographics
NPI:1700406071
Name:WAGNER, NATHAN (ND)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:WAGNER
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TOMAHAWK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-8118
Mailing Address - Country:US
Mailing Address - Phone:724-562-2712
Mailing Address - Fax:
Practice Address - Street 1:116 3RD ST STE 215
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2193
Practice Address - Country:US
Practice Address - Phone:800-277-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4311175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath