| NPI | 1568776482 |
|---|---|
| Former Name | DANA MAE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4105-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 4105-33) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2025-04-14 |