Individual
SAMANTHA WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3702 AUTOMATION WAY STE 103, FORT COLLINS, CO 80525-5738
(970) 224-2985
Mailing address
866 S REED CT APT F, LAKEWOOD, CO 80226-4497
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
22583017
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
126640
CO
Other
Enumeration date
10/30/2019
Last updated
05/18/2020
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