Nicole Marie Wagner, LSA
Specialist/Technologist, Other, Surgical Assistant in Wylie, TX. Individual provider (NPI-1).
NPI number1831986017
StatusActive
Last updated in NPPESApr 22, 2025
Details
- NPI
- 1831986017
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Nicole Marie Wagner
- Credential
- LSA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 22, 2025
- Certification date
- Apr 22, 2025
- Last updated
- Apr 22, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZC0007X | Specialist/Technologist, Other, Surgical Assistant | SA00976 | TX | Yes |
Practice location
409 Kathy LnWylie, TX 75098-4544
Phone 817-897-8481
Mailing address
409 Kathy LnWylie, TX 75098-4544
Phone 817-897-8481
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