Individual
DEVON WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
5708 E. LAKE SAMMANISH PKWY SE, ISSAQUAH, WA 98029
(425) 688-5777
Mailing address
5708 E. LAKE SAMMANISH PKWY SE, ISSAQUAH, WA 98029
(425) 688-5777
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
60929310
WA
363LP2300X
Primary Care Nurse Practitioner
Primary
AP61598671
WA
Other
Enumeration date
01/23/2024
Last updated
08/23/2024
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