Individual
MRS. GWENYTH GRACE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
407 S CLAIRBORNE RD, OLATHE, KS 66062-1857
(913) 393-9921
Mailing address
405 S CLAIRBORNE RD STE 2, OLATHE, KS 66062-1774
(913) 730-3661
(913) 768-1944
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
53-74969
KS
Other
Enumeration date
07/12/2013
Last updated
03/23/2021
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