| NPI | 1184934655 |
|---|---|
| Former Name | HOLLY A WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.11710-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.349162) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2013-02-25 |