Individual
LANA K WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4100 HIGH RESORT BLVD SE, PMG RIO RANCHO HIGH RESORT 4100, RIO RANCHO, NM 87124-5901
(505) 462-8520
(505) 462-8510
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2000303
NM
207QS1201X
Sleep Medicine (Family Medicine) Physician
Primary
2000-303
NM
Other
Enumeration date
12/01/2005
Last updated
10/29/2015
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