| NPI | 1023502549 |
|---|---|
| Former Legal Business Name | ELIZABETH WAGGONER PMHNP-BC LLC |
| Entity Type | Organization |
| Authorized Contact | MARY ELIZABETH WAGGONER President 720-262-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0770900) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 09923992) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2020-10-30 |