| NPI | 1730635681 |
|---|---|
| Former Name | KENSIE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006978A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28216896A) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2018-08-01 |