Individual
ALI E WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1115 LANE 12, LOVELL, WY 82431-9537
(307) 548-5201
Mailing address
1115 LANE 12, LOVELL, WY 82431-9537
(307) 548-5201
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
F01200522
NM
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
45489
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F01200522
AANP
—
Enumeration date
02/11/2020
Last updated
02/03/2026
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