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General NPI Number Information
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NPI Number | 1770781551
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Entity Type | Individual
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Provider Name | ADOLIA JEAN WAGNER RN
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1901 E 1ST ST
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City | NEWTON
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State | KS
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Zip | 67114-5010
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Country | US
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Telephone | 316-284-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 310 N RIDGEWOOD DR
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City | WICHITA
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State | KS
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Zip | 67208-4159
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 14-91066-091
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License Number State | KS
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