| NPI | 1598023939 |
|---|---|
| Other Name | KIMBERLY ANN WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3083-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004647) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2025-08-15 |