Provider Demographics
NPI:1013753920
Name:WAGLEY, MEERA
Entity type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:WAGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 SLOAN PL STE 50B
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2173
Mailing Address - Country:US
Mailing Address - Phone:651-447-2255
Mailing Address - Fax:
Practice Address - Street 1:1973 SLOAN PL STE 50B
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2173
Practice Address - Country:US
Practice Address - Phone:651-447-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health