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Individual

COURTNEY LEE WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
6261 OLD BETHEL RD, CRESTVIEW, FL 32536-5507
(850) 683-7500
(850) 683-7523
Mailing address
221 HOSPITAL DR NE, FORT WALTON BEACH, FL 32548-5066
(850) 833-9240

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5178468
FL

Other

Enumeration date
10/25/2007
Last updated
10/25/2007
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