Individual
SHARISE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
16240 N FORT MCDOWELL RD, FORT MCDOWELL, AZ 85264-3402
(480) 789-7890
Mailing address
1522 W 6TH DR, MESA, AZ 85202-2023
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN173427
AZ
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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