NPI 1417402397

Ebony Wagner

Practitioner Licensed Practical Nurse Florissant, MO

Practice location

Address: 2325 Patterson Rd, Florissant, MO 63031-2205
Phone: (314) 620-5553
Fax: (314) 584-5002

Registered specialties

Licensed Practical Nurse Primary

Nursing Service Providers Taxonomy 164W00000X Licence 2013023536 (MO)

Other Licensed Practical Nurse providers in Missouri →

Registry record

NPI: 1417402397
Entity type: Individual
Sex (as registered): Female
NPI issued: 19 Aug 2016
Record last updated: 19 Aug 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.