| NPI | 1689762866 |
|---|---|
| Former Name | SANDRA D WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD R029388) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD SD-CNP CP000350) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2013-02-06 |