# PENELOPE ANDREA WAGNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1164608477
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WG0600X | Gerontology Registered Nurse | RN-75898 | CO | — |
| 363LA2200X | Adult Health Nurse Practitioner | APN.0005547-NP | CO | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | 5547 | CO | — |

## Other

- **Enumeration date:** 01/16/2008
- **Last updated:** 07/16/2026