Bethany Gale Wagener, PA-C

NPI #1063711190 in Oklahoma City, Oklahoma

Provider Information

NPI Number: 1063711190
Entity Type: Individual
Name: Bethany Gale Wagener, PA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Mar 15, 2011
Last Updated: Mar 15, 2011

Practice Location

Address: 2901 N CLASSEN BLVD
Address 2: SUITE 200
City: Oklahoma City
State: Oklahoma
ZIP Code: 73106-5493
Phone: (918) 594-1300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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