| NPI | 1164045209 |
|---|---|
| Former Name | STORMIE RAE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS022997) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT020219) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA OS022997) | |
| Enumeration Date | 2020-05-23 |
| Last Update Date | 2023-08-10 |