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1447598362
JACQUELINE LEE WAGNER
COEUR D ALENE, ID
NPI
1447598362
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Former Name
JACQUELINE LEE CRUZ-AEDO
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
207Q00000X Family Medicine
(Licence: ID NP1283A)
Enumeration Date
2013-01-28
Last Update Date
2016-08-17
Business Address
-- JACQUELINE LEE WAGNER ARNP
1713 E SHERMAN AVE
COEUR D ALENE, ID 83814-5326
Phone number: 208-966-4087
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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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