Individual
LISA CARROLL WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, COHN-S
Contact information
Practice address
5444 FULLERTON CIR, HIGHLANDS RANCH, CO 80130-6642
(910) 409-8509
Mailing address
5444 FULLERTON CIR, HIGHLANDS RANCH, CO 80130-6642
(910) 409-8509
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
RN.1632465
CO
Other
Enumeration date
06/19/2016
Last updated
06/19/2016
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