| NPI | 1801862784 |
|---|---|
| Former Name | NORA L WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1754) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 05-29277) |
| 363A00000X Physician Assistant (Licence: OK 1852) | |
| 363A00000X Physician Assistant (Licence: VA 0110004220) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2022-12-08 |