| NPI | 1285870337 |
|---|---|
| Former Name | AMY ELIZABETH WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP3853) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 13869) |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2014-04-07 |