| NPI | 1558756247 |
|---|---|
| Former Name | DESIREE NICOLE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 317188) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: PA MD463914) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 317188) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2023-07-22 |