Individual
MRS. CAROLE EATON WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
500 HWY 89 NORTH, NORTHERN AZVA HEALTHCARE SYSTEM, PRESCOTT, AZ 86313
(928) 445-4860
(928) 776-6147
Mailing address
PO BOX 206, HUMBOLDT, AZ 86329-0206
(928) 632-5550
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN036104
AZ
Other
Enumeration date
10/04/2005
Last updated
10/26/2010
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