Individual
COLLEEN M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A-GNP-C
Contact information
Practice address
14 RIDGEDALE AVE STE 103, CEDAR KNOLLS, NJ 07927-1106
(973) 295-6335
Mailing address
14 RIDGEDALE AVE STE 103, CEDAR KNOLLS, NJ 07927-1106
(973) 295-6335
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
26NJ00855900
NJ
363LA2200X
Adult Health Nurse Practitioner
F310566
NY
363LG0600X
Gerontology Nurse Practitioner
26NJ00855900
NJ
363LG0600X
Gerontology Nurse Practitioner
F310566
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ00855900
NJ
Other
Enumeration date
11/10/2015
Last updated
02/22/2023
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