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NPI Code Detail

MEDICARE: GLAUCIA MARLI WAGNER ARNP

MEDICARE: GLAUCIA MARLI WAGNER ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP 3323462FL

General Provider Information

NPI Number : 1083954440
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLAUCIA MARLI WAGNER ARNP
Provider Business Mailing Address
First Line : 1851 QUARLEY PL
Second Line :
City : HENDERSON
State : NV
Zip : 89014-3875
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1701 W CHARLESTON BLVD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2313
Country : US
Telephone Number : 702-251-8000
Fax Number : 702-471-0120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2013
Last Update Date : 04/07/2022

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