Individual
SOPHIA COLLETTE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4320 HOUMA BLVD FL 5, METAIRIE, LA 70006-2961
(504) 503-6565
(504) 456-8053
Mailing address
4200 HOUMA BLVD, METAIRIE, LA 70006-2970
(504) 503-6781
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
226793
LA
Other
Enumeration date
07/25/2022
Last updated
09/15/2022
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