Individual
DIANE KATHLEEN CORT-WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP
Contact information
Practice address
622 AIRPORT RD, PENDLETON, OR 97801-4598
(541) 276-0057
Mailing address
622 AIRPORT RD, PENDLETON, OR 97801-4598
(541) 276-0057
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
085075504N1 FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085075504N1 FNP-PP
OREGON STATE BOARD OF NUR
OR
Enumeration date
09/27/2007
Last updated
09/27/2007
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