Individual
CHRISTA M WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP
Contact information
Practice address
7330 N 99TH AVE STE 325, GLENDALE, AZ 85307-3022
(480) 840-1769
(480) 840-1785
Mailing address
3815 E BELL RD STE 2200, PHOENIX, AZ 85032-2139
(602) 633-3884
(602) 633-3841
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP-03457
NM
363LF0000X
Family Nurse Practitioner
CNP-03457
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80301398
—
NM
Enumeration date
11/28/2017
Last updated
07/01/2021
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