NPI | 1316571755 |
---|---|
Former Name | AMANDA RENEE WAGNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144989) |
Additional Taxonomies | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: TX AP144989) |
Enumeration Date | 2020-02-25 |
Last Update Date | 2024-04-15 |