Individual
DONNELLE I. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
4620 ROGERS AVE, FORT SMITH, AR 72903-3149
(479) 384-5380
(479) 384-5382
Mailing address
4620 ROGERS AVE, FORT SMITH, AR 72903-3149
(479) 384-5380
(479) 384-5382
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ATP000123
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168334758
—
AR
05
—
200130940A
—
OK
Enumeration date
01/02/2008
Last updated
09/13/2024
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