Individual
AMANDA C WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 W 10TH ST, ROLLA, MO 65401
(573) 458-8899
(573) 341-5611
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 458-8899
(573) 341-5611
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2024020234
MO
367500000X
Certified Registered Nurse Anesthetist
786638
NY
367500000X
Certified Registered Nurse Anesthetist
RN9407106
FL
Other
Enumeration date
03/22/2020
Last updated
09/11/2024
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