JACQUELINE LEE WAGNER

COEUR D ALENE, ID
NPI1447598362
Former NameJACQUELINE LEE CRUZ-AEDO
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy207Q00000X Family Medicine
(Licence: ID  NP1283A)
Enumeration Date2013-01-28
Last Update Date2016-08-17
Business Address
-- JACQUELINE LEE WAGNER ARNP
1713 E SHERMAN AVE
COEUR D ALENE, ID 83814-5326
Phone number: 208-966-4087
Mailing Address
-- JACQUELINE LEE WAGNER ARNP
1713 E SHERMAN AVE
COEUR D ALENE, ID 83814-5326
Phone number: 208-966-4087
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