| NPI | 1710955273 |
|---|---|
| Former Name | LISA K WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60587860) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 45580) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2015-09-24 |