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Individual
TYLR AUSTIN WAGNER
Active
Individual
TYLR AUSTIN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201507408RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201706858NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP60776226
WA
Other
Enumeration date
09/02/2006
Last updated
10/02/2017
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