| 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 |