Individual
NICOLE J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1380 E MEDICAL CENTER DR, ST GEORGE, UT 84790-2123
(435) 251-2500
(435) 656-4907
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12160799-4405
UT
363L00000X
Nurse Practitioner
5723
WI
Other
Enumeration date
03/22/2014
Last updated
06/20/2024
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