Individual
JANELLE JOY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1760 E KEN PRATT BLVD STE 301&302, LONGMONT, CO 80504-5311
(303) 684-1900
(303) 684-1925
Mailing address
7951 E MAPLEWOOD AVE STE 350, GREENWOOD VILLAGE, CO 80111-4758
(303) 930-7803
(039) 305-5033
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP10340
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61605271
—
CO
Enumeration date
05/24/2010
Last updated
05/15/2023
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