Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | LE-00037237 | OH |
NPI | 1023686771 |
---|---|
Provider Name | Alana Wagner |
First Address | Columbus, OH 43210-1240 |
Second Address | Columbus, OH 43210-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2021 |
Last Update Date | 17/06/2021 |