Individual
CAROLINE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 S MAIN ST, LAMAR, CO 81052-3838
(719) 336-8721
Mailing address
8896 RD. EE, LAS ANIMAS, CO 81054
(719) 456-0641
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
68437
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18988814
—
CO
Enumeration date
03/08/2007
Last updated
07/08/2007
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