| NPI | 1629444823 |
|---|---|
| Former Name | STEPHANIE LAUREN WAGGONER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: IL 209013055) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2022-05-10 |