| NPI | 1285954404 |
|---|---|
| Former Name | LAURIE A WAGONER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN22148) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024168827) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2024-01-29 |