| NPI | 1831576198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI WAGNER Mg Mbr 859-967-9486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3002772) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2015-06-17 |