Individual
KAYLA LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9690 E 116TH ST, FISHERS, IN 46037-2838
(317) 214-5750
Mailing address
13226 KOMATITE WAY UNIT 400, FISHERS, IN 46038-5444
(502) 689-3817
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28230305A
IN
363L00000X
Nurse Practitioner
Primary
71012185A
IN
Other
Enumeration date
01/05/2022
Last updated
03/03/2022
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