Healthcare Provider Details

I. General information

NPI: 1821828559
Provider Name (Legal Business Name): BRITTANY WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7293 W SAHARA AVE STE 103
LAS VEGAS NV
89117-2855
US

IV. Provider business mailing address

1668 EL SUENO CT
MESQUITE NV
89027-7052
US

V. Phone/Fax

Practice location:
  • Phone: 725-205-3202
  • Fax:
Mailing address:
  • Phone: 775-848-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: