Provider Demographics
NPI:1760735815
Name:WAGNER, SARAH BENTON (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BENTON
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 DURHAM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-2741
Mailing Address - Country:US
Mailing Address - Phone:336-322-1024
Mailing Address - Fax:336-322-1022
Practice Address - Street 1:3762 DURHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-2741
Practice Address - Country:US
Practice Address - Phone:336-322-1024
Practice Address - Fax:336-322-1022
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily