Individual
STACIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
300 W CLARENDON AVE, 375, PHOENIX, AZ 85013-3420
(602) 277-4161
(602) 274-3394
Mailing address
300 W CLARENDON AVE, 375, PHOENIX, AZ 85013-3420
(602) 277-4161
(602) 274-3394
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2122
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
443713
—
AZ
Enumeration date
07/19/2006
Last updated
07/08/2007
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