Provider Demographics
NPI:1043843675
Name:WAGAR, CAYLAN ROSE (DOULA)
Entity type:Individual
Prefix:
First Name:CAYLAN
Middle Name:ROSE
Last Name:WAGAR
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36645 GORE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9603
Mailing Address - Country:US
Mailing Address - Phone:541-223-3237
Mailing Address - Fax:
Practice Address - Street 1:36645 GORE DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9603
Practice Address - Country:US
Practice Address - Phone:541-223-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000003569374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula