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1861738981
KELLY JO WAGNER
ARVADA, CO
NPI
1861738981
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LA2100X Nurse Practitioner, Acute Care
(Licence: CO 0990570)
Enumeration Date
2012-12-17
Last Update Date
2016-03-04
Business Address
-- KELLY JO WAGNER
12650 W 64TH AVE UNIT E501
ARVADA, CO 80004-3893
Phone number: 303-431-4127
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Mailing Address
-- KELLY JO WAGNER
6595 ZINNIA ST
ARVADA, CO 80004-2256
Phone number: 937-243-1014
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