Individual
LISA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1250 BROADWAY, 17TH FLOOR, VISITING NURSE SERVICE OF NEW YORK, NEW YORK, NY 10001
(212) 465-2751
Mailing address
170 E 87TH ST, PH2B, NEW YORK, NY 10128-2214
(917) 492-8702
(917) 492-8702
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
430343
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LW385602
NYS HEALTH COMMERCE SYSTEM
NY
Enumeration date
05/23/2007
Last updated
10/22/2014
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