Provider Demographics
NPI:1821250671
Name:WAGNER, ERIN ABLE (MPA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ABLE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:704-324-3975
Mailing Address - Fax:704-324-3974
Practice Address - Street 1:17078 NAT BYNUM LN UNIT 3
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-0507
Practice Address - Country:US
Practice Address - Phone:704-324-3975
Practice Address - Fax:704-324-3974
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-05915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant