Individual
CASEY RAE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
5325 FARAON ST., ST. JOSEPH, MO 64506-3488
(816) 271-6000
Mailing address
901 HEARTLAND RD, STE. 2800, ST. JOSEPH, MO 64506-6201
(816) 271-1200
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
2011028689
MO
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
75395
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750659777
—
MO
05
—
200750820A
—
KS
Enumeration date
12/05/2011
Last updated
10/30/2017
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