Doctor Name: | MICHAELA WAGNER |
NPI Number: | 1295136463 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, BSN, CLC |
License Number: | RN173588 |
Business Practice Address: | 20484 W Hamilton St Buckeye, AZ - 853967780 |
Business Phone Number: | 4806865054 |
Business Fax Number: | |
Mailing Address: | 20484 W Hamilton St, BUCKEYE |
State: | AZ |
Postal Code: | 853967780 |
Phone Number: | 4806865054 |
Fax Number: | |
NPI Enumeration Date: | 09/08/2014 |
NPI Last Update Date: | 09/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WL0100X |
License Number: | RN173588 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Lactation Consultant |
Taxonomy Definition: |