Provider Demographics
NPI:1952335077
Name:WAGANER, KAREN MAE (PNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MAE
Last Name:WAGANER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MAE
Other - Last Name:WAGANER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC,PNP
Mailing Address - Street 1:2113 ADAMS GRV STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6957
Mailing Address - Country:US
Mailing Address - Phone:803-256-0531
Mailing Address - Fax:803-765-9052
Practice Address - Street 1:2113 ADAMS GRV STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6957
Practice Address - Country:US
Practice Address - Phone:803-256-0531
Practice Address - Fax:803-765-9052
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP3932363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics