Individual
MRS. LEILANI LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1800 COFFEE ROAD SUITE 37, MODESTO, CA 95355
(209) 572-7136
(209) 491-7595
Mailing address
1800 COFFEE ROAD SUITE 37, MODESTO, CA 95355
(209) 572-7136
(209) 491-7595
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
RN966643
DC
363LX0106X
Occupational Health Nurse Practitioner
Primary
95001675
CA
Other
Enumeration date
02/26/2013
Last updated
08/07/2019
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