Individual
KELLY JO WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12650 W 64TH AVE, UNIT E501, ARVADA, CO 80004-3893
(303) 431-4127
(303) 431-4553
Mailing address
6595 ZINNIA ST, ARVADA, CO 80004-2256
(937) 243-1014
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
0990570
CO
Other
Enumeration date
12/17/2012
Last updated
03/04/2016
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