| NPI | 1356432595 |
|---|---|
| Former Name | KATHRYN ANN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05896) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA505) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-12-23 |