Organization
KATHLEEN T. WAGNER, MD, PC
Active
Other names
Pioneer Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN T. WAGNER M.D. (MEDICAL DIRECTOR)
(702) 364-9988
Entity
Organization
Contact information
Practice address
3120 S RAINBOW BLVD, SUITE 202, LAS VEGAS, NV 89146-6236
(702) 364-9988
(702) 364-0880
Mailing address
PO BOX 81348, LAS VEGAS, NV 89180-1348
(702) 364-9988
(702) 364-0880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9669
NV
Other
Enumeration date
03/03/2008
Last updated
03/03/2008
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