Individual
CARLY JEAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
50 IRVING ST NW, WASHINGTON, DC 20422-0001
(202) 717-6846
(830) 239-9756
Mailing address
50 IRVING ST NW, WASHINGTON, DC 20422-0001
(202) 745-8000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024175304
VA
Other
Enumeration date
09/07/2017
Last updated
08/16/2023
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