Individual
KRISTY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
934 CONGRESS ST, PORTLAND, ME 04102-3032
(207) 874-2141
(207) 874-2164
Mailing address
180 PARK AVE, PORTLAND, ME 04102-2957
(207) 874-2141
(207) 874-2164
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN84059
ME
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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