Individual
MRS. LANE GRAY WAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
525 WESTERN AVE, SUITE 202, CONWAY, AR 72034-4967
(501) 513-5337
(501) 513-5338
Mailing address
525 WESTERN AVE, SUITE 202, CONWAY, AR 72034-4967
(501) 513-5337
(501) 513-5338
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
A02902
AR
Other
Enumeration date
07/03/2008
Last updated
08/13/2020
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