| NPI | 1114758265 |
|---|---|
| Former Name | MADELINE LEE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70050351) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60934089) |
| Enumeration Date | 2024-08-12 |
| Last Update Date | 2025-11-16 |