Individual
KATHERINE ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP-BC, NP-C
Contact information
Practice address
2951 FULTON AVE, SACRAMENTO, CA 95821-4909
(916) 486-7555
(916) 486-7557
Mailing address
2951 FULTON AVE, SACRAMENTO, CA 95821-4909
(916) 486-7555
(916) 486-7557
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
21313
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
21313
CA
363LP2300X
Primary Care Nurse Practitioner
21313
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538446117
MEDI/MEDI, COMMERCIAL INSURANCE CONTRACTED WITH CLINIC
CA
Enumeration date
11/09/2011
Last updated
03/13/2014
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