Individual
LISHA INEZ WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
815 WEST FIFTH NORTH STREET, MORRISTOWN, TN 37814
(423) 586-5032
(423) 581-8473
Mailing address
DEPARTMENT 888182, KNOXVILLE, TN 37995-8182
(800) 355-3565
(423) 714-2355
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN100615
TN
Other
Enumeration date
10/17/2007
Last updated
10/17/2007
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