Individual
MRS. KEELIE MADISON WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CPNP-PC
Contact information
Practice address
5435 EMERSON WAY STE 100, INDIANAPOLIS, IN 46226-1470
(317) 362-0293
Mailing address
4350 S BROOKLAWN DR, NEW PALESTINE, IN 46163-9738
(317) 752-5446
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
71015385A
IN
Other
Enumeration date
08/30/2023
Last updated
07/03/2024
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