Individual
HEATHER WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9800 BROADWAY EXT STE 200, OKLAHOMA CITY, OK 73114-6304
(405) 715-4496
Mailing address
9800 BROADWAY EXT STE 200, OKLAHOMA CITY, OK 73114-6304
(405) 715-4496
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R 0088946
OK
Other
Enumeration date
01/15/2014
Last updated
09/24/2024
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