Individual
KAYLA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
4600 BROADWAY, NEW YORK, NY 10040-2102
(212) 949-4957
Mailing address
4 W 125TH ST, 2ND FLOOR, NEW YORK, NY 10027-4567
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
382700
NY
Other
Enumeration date
12/08/2016
Last updated
12/11/2016
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