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Individual
SCOTT JOHN WAGNER
Active
Individual
SCOTT JOHN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNOR RNFA
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
695886
TX
363LF0000X
Family Nurse Practitioner
Primary
1018610
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
695886
RN
TX
Enumeration date
07/16/2007
Last updated
11/30/2020
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