Individual provider · Type 1 NPI

Martha Laine Wagoner, FNP

Family Nurse Practitioner · North Charleston, SC

NPI number 1497129563 Active

Practice location

2102 Otranto Blvd
North Charleston, SC 29406-9841

Mailing address

1010 River Haven Cir, Apt A
Charleston, SC 29412-4121

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000X19800 (SC)

Family Nurse Practitioner: Definition to come...

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About NPI 1497129563

Martha Laine Wagoner, FNP's National Provider Identifier is 1497129563, issued on Nov 30, 2015. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in North Charleston, SC. The record was last updated on Nov 30, 2015.