Shy L Wagoner, CST
NPI #1164655452 in Springfield, Illinois
Provider Information
- NPI Number
- 1164655452
- Entity Type
- Individual
- Name
- Shy L Wagoner, CST
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Specialist/Technologist, Other - Surgical Technologist
- Credential
- CST
- Enumeration Date
- Sep 2, 2009
- Last Updated
- Feb 17, 2012
Practice Location
- Address
- 2921 MONTVALE DR
- City
- Springfield
- State
- Illinois
- ZIP Code
- 62704-5359
- Phone
- (217) 787-2700
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist/Technologist, Other - Surgical Technologist — Surgical Technologist |
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