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Individual
MRS. KRISTINE LEE WAGNER
Active
Individual
MRS. KRISTINE LEE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085009524
IL
363A00000X
Physician Assistant
PA.000845
CO
363A00000X
Physician Assistant
PA9101686
FL
363AS0400X
Surgical Physician Assistant
PA9101686
FL
Other
Enumeration date
12/18/2006
Last updated
12/04/2025
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