Individual
KIRSTEN U WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4314 W SLAUSON AVE, LOS ANGELES, CA 90043
(323) 293-7171
(310) 531-2084
Mailing address
4314 W SLAUSON AVE, LOS ANGELES, CA 90043
(323) 293-7171
(310) 531-2084
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10936
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP10936
BOARD OF REG NURSING
CA
Enumeration date
08/20/2006
Last updated
07/08/2007
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