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1639641889
KEISHA LYNN WAGNER
BROOKLYN, NY
NPI
1639641889
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: NY F343619-1)
Enumeration Date
2018-12-28
Last Update Date
2018-12-28
Business Address
KEISHA LYNN WAGNER
273 PUTNAM AVE
BROOKLYN, NY 11216-1613
Phone number: 917-682-4643
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Mailing Address
KEISHA LYNN WAGNER
273 PUTNAM AVE
BROOKLYN, NY 11216-1613
Phone number: 917-682-4643
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