| NPI | 1245654771 |
|---|---|
| Former Name | LAURA WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP029186) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00482500) |
| 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00482500) | |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2024-03-21 |