Healthcare Provider Details

I. General information

NPI: 1750832093
Provider Name (Legal Business Name): SONYA WAGANER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONYA KING

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8036 S DEER CREEK CANYON RD
MORRISON CO
80465-9530
US

IV. Provider business mailing address

8036 S DEER CREEK CANYON RD
MORRISON CO
80465-9530
US

V. Phone/Fax

Practice location:
  • Phone: 303-875-3128
  • Fax:
Mailing address:
  • Phone: 303-875-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992667-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: