Individual
PENELOPE ANDREA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5920 MCINTYRE ST, GOLDEN, CO 80403-7445
(303) 949-1250
Mailing address
5920 MCINTYRE ST, GOLDEN, CO 80403-7445
(303) 949-1250
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
RN-75898
CO
363LG0600X
Gerontology Nurse Practitioner
Primary
5547
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60500034
—
CO
Enumeration date
01/16/2008
Last updated
01/22/2016
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