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General NPI Number Information
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NPI Number | 1447927751
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Entity Type | Individual
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Provider Name | TRICIA WAGNER NP
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Gender | Female
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 101 BODIN CIR
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-5431
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Fax |
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Provider Business Mailing Address
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Address Line | 545 EVANS RD
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City | DIXON
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State | CA
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Zip | 95620-4418
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Country | US
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Telephone | 925-301-5502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95017980
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License Number State | CA
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