Individual
GABRIELLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 WALNUT ST FL 20, PHILADELPHIA, PA 19107-5176
(215) 829-8455
Mailing address
800 WALNUT ST FL 20, PHILADELPHIA, PA 19107-5176
(215) 829-8455
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
SP025758
PA
363LF0000X
Family Nurse Practitioner
Primary
SP025758
PA
Other
Enumeration date
09/27/2022
Last updated
09/27/2022
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