Individual
DEB AGNES WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1008 PATTON STREET, FORT COLLINS, CO 80525
(970) 494-4200
Mailing address
4856 INNOVATION DR STE B, FORT COLLINS, CO 80525-5540
(970) 494-4200
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0046580
CO
Other
Enumeration date
12/11/2020
Last updated
12/11/2020
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