Amanda C Wagner
Nurse Anesthetist, Certified Registered in Rolla, MO. Individual provider (NPI-1).
NPI number1164058020
StatusActive
Last updated in NPPESSep 11, 2024
Details
- NPI
- 1164058020
- Entity type
- Individual (NPI-1)
- Name
- Amanda C Wagner
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 22, 2020
- Certification date
- Sep 11, 2024
- Last updated
- Sep 11, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 2024020234 | MO | Yes |
| 367500000X | Nurse Anesthetist, Certified Registered | RN9407106 | FL | |
| 367500000X | Nurse Anesthetist, Certified Registered | 786638 | NY |
Practice location
1000 W 10th StRolla, MO 65401
Phone 573-458-8899 · Fax 573-341-5611
Mailing address
1050 W 10th StRolla, MO 65401-2905
Phone 573-458-8899 · Fax 573-341-5611
Other practice locations
5645 Main St
Flushing, NY 11355-5045
Flushing, NY 11355-5045
Phone 718-670-2000
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All 23 Certified Registered Nurse Anesthetist providers in Rolla · All 863 providers in Rolla
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