| NPI | 1205364007 |
|---|---|
| Former Name | TARA LYNN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.020528) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 365623) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2022-11-23 |