Individual
LISA MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN NP-C
Contact information
Practice address
249 KODIAK DR UNIT 201, BASALT, CO 81621-8140
(970) 618-8796
(970) 645-3168
Mailing address
249 KODIAK DR UNIT 201, BASALT, CO 81621-8140
(970) 618-8796
(970) 645-3168
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN.0993561-NP
CO
Other
Enumeration date
11/30/2017
Last updated
05/07/2025
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