# KATHLEEN MARY WAGNER

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

## Provider details

- **NPI number:** 1740397041
- **Gender:** F
- **Credential:** ARNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | AP30000510 | WA | — |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | ARNP9333175 | FL | Yes |

## Other

- **Enumeration date:** 08/23/2006
- **Last updated:** 09/07/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0212946 | LABOR & INDUSTRIES | WA |
| 05 | — | 807564400 | — | ID |
| 05 | — | 9649823 | — | WA |