Individual
MRS. JULIE ANN WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP,ARNP
Contact information
Practice address
2555 BERKSHIRE PKWY, CLIVE, IA 50325-4646
(515) 987-0051
(515) 987-0054
Mailing address
2555 BERKSHIRE PKWY, CLIVE, IA 50325-4646
(515) 987-0051
(515) 987-0054
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
C-078227
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0478958
—
IA
Enumeration date
02/22/2006
Last updated
12/23/2016
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