Individual
LAURA WAGNOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21258 N 81ST AVE, PEORIA, AZ 85382-4418
(623) 412-4900
Mailing address
15949 W WINSLOW AVE, GOODYEAR, AZ 85338-9436
(623) 414-1507
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
249191
AZ
Other
Enumeration date
08/19/2025
Last updated
08/19/2025
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