Individual
MISS MALLORI JANE WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2724 AVENUE B, COUNCIL BLUFFS, IA 51501-2106
(402) 679-2834
Mailing address
21 INDIAN HILLS RD, COUNCIL BLUFFS, IA 51503-4843
(402) 679-2834
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
06/04/2025
Last updated
06/04/2025
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