NPI | 1033740980 |
---|---|
Former Name | JESSICA LACHELLE WAGNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: TX 1076101) |
Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MD AC002979) |
363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MD R214732) | |
Enumeration Date | 2020-01-29 |
Last Update Date | 2024-04-30 |