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General NPI Number Information
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NPI Number | 1992471437
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Entity Type | Individual
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Provider Name | GWENDOLYN DIANNE WAGNER RN, DNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 26045 SHADOW ROCK LN
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City | VALENCIA
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State | CA
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Zip | 91381-0632
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Country | US
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Telephone | 818-259-2732
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 801749
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City | SANTA CLARITA
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State | CA
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Zip | 91380-1749
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Country | US
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Telephone | 818-259-2732
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018063
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 406827
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License Number State | CA
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