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1407180268
KELLY ANN WAGNER
WEST BEND, WI
NPI
1407180268
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: WI 302197-031)
Enumeration Date
2009-09-28
Last Update Date
2009-09-28
Business Address
Ms. KELLY ANN WAGNER lpn
1143 VOGT DR APT 14
WEST BEND, WI 53095-5505
Phone number: 262-483-8439
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Mailing Address
Ms. KELLY ANN WAGNER lpn
1143 VOGT DR APT 14
WEST BEND, WI 53095-5505
Phone number: 262-483-8439
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