Provider Demographics
NPI:1801621222
Name:WAGNER, ASHLEY (RT(R))
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SHYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9743
Mailing Address - Country:US
Mailing Address - Phone:740-708-9509
Mailing Address - Fax:
Practice Address - Street 1:2700 SHYVILLE RD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9743
Practice Address - Country:US
Practice Address - Phone:740-708-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR8862612247100000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist