Individual
KATHRYN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9030 WESTERN AVE, OMAHA, NE 68114-2265
(402) 390-8207
Mailing address
1921 S 149TH CIR, OMAHA, NE 68144-2005
(402) 740-8736
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
H14076939
NE
Other
Enumeration date
02/06/2025
Last updated
02/06/2025
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