MEDICARE: MS. HEATHER FLANAGAN-WAGNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0198398	CO

General Provider Information

NPI Number	:	1093258840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER FLANAGAN-WAGNER

Provider Business Mailing Address
First Line	:	3810 S FENTON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80235-2919
Country	:	US
Telephone Number	:	720-224-8454
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 S FENTON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80235-2919
Country	:	US
Telephone Number	:	720-224-8454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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