Individual
MRS. KRISTINE MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2308 WESVILLE CT., RALEIGH, NC 27607-2949
(919) 781-4311
Mailing address
PO BOX 535395, ATLANTA, GA 30353-5321
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
251798
NC
Other
Enumeration date
09/26/2011
Last updated
09/17/2012
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