Provider Demographics
NPI:1952572794
Name:WAGMAN, ABBY ELISE (LAC)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:ELISE
Last Name:WAGMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 SE 11 COURT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1144
Mailing Address - Country:US
Mailing Address - Phone:954-673-1504
Mailing Address - Fax:
Practice Address - Street 1:416 SE 11TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1144
Practice Address - Country:US
Practice Address - Phone:954-673-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2360171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist