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 |