Individual
AMANDA MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
8670 BIG BEND BLVD STE A, SAINT LOUIS, MO 63119-3839
(314) 447-1900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2021002285
MO
363LF0000X
Family Nurse Practitioner
2021002285
MO
Other
Enumeration date
01/28/2021
Last updated
07/14/2023
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