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Individual
CASSIE J WAGNER
Active
Individual
CASSIE J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
C112229
IA
363LP0200X
Pediatric Nurse Practitioner
C112229
IA
363LP0200X
Pediatric Nurse Practitioner
Primary
C156954
IA
363LP0222X
Critical Care Pediatric Nurse Practitioner
C112229
IA
Other
Enumeration date
10/17/2014
Last updated
12/03/2019
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