| NPI | 1992184147 |
|---|---|
| Former Name | COURTNEY L. WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5340) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003314) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2018-07-12 |