Individual
MS. LORI A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1078503
KY
363L00000X
Nurse Practitioner
3002772
KY
363LA2100X
Acute Care Nurse Practitioner
3002772
KY
363LA2200X
Adult Health Nurse Practitioner
Primary
3002772
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1078503
REGISTERED NURSE
KY
01
—
11221661
CAQH
—
01
—
3002772
ADVANCED PRACTICE REGISTERED NURSE
KY
05
—
78000007
—
KY
Enumeration date
09/12/2005
Last updated
07/27/2023
Update your record
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