| Doctor Name: | MS. ALEXIS DEBORAH WAGNER |
| NPI Number: | 1023107091 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | RN16715 |
| Business Practice Address: | 910 Brooks St Suite 202 Missoula, MT - 598015783 |
| Business Phone Number: | 4065418060 |
| Business Fax Number: | 4065418062 |
| Mailing Address: | 910 Brooks St, Suite 202 MISSOULA |
| State: | MT |
| Postal Code: | 598015783 |
| Phone Number: | 4065418060 |
| Fax Number: | 4065418062 |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 02/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN16715 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |