Individual provider · Type 1 NPI

Ebony Wagner

Licensed Practical Nurse · Florissant, MO

NPI number 1417402397 Active

Practice location

2325 Patterson Rd
Florissant, MO 63031-2205

Call (314) 620-5553 Map

Fax (314) 584-5002

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X2013023536 (MO)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1417402397

Ebony Wagner's National Provider Identifier is 1417402397, issued on Aug 19, 2016. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Florissant, MO. The record was last updated on Aug 19, 2016.