Doctor Name: | LOIS WAGLEY |
NPI Number: | 1538530506 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 71005871A |
Business Practice Address: | 1953 Waterfall Dr Ste A Nappanee, IN - 465508961 |
Business Phone Number: | 5747734101 |
Business Fax Number: | |
Mailing Address: | 1953 Waterfall Dr, Ste A NAPPANEE |
State: | IN |
Postal Code: | 465508961 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/15/2015 |
NPI Last Update Date: | 03/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71005871A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |