Individual
JACQUELINE LEE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1713 E SHERMAN AVE, COEUR D ALENE, ID 83814-5326
(208) 966-4087
(208) 966-4031
Mailing address
1713 E SHERMAN AVE, COEUR D ALENE, ID 83814-5326
(208) 966-4087
(208) 966-4031
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NP1283A
ID
Other
Enumeration date
01/28/2013
Last updated
08/17/2016
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