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Individual

MS. AIMEE THERESE WAGONBLAST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
151 NE HAMPE WAY SUITE B2-6, CHEHALIS, WA 98532
(360) 748-3049
(360) 748-2129
Mailing address
516 SANDALWOOD DR SW, OLYMPIA, WA 98502
(360) 581-2646

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP30007079
WA

Other

Enumeration date
11/13/2006
Last updated
06/21/2011
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