KATHLEEN T. WAGNER, MD, PC
Marriage and Family Therapists at Rainbow Blvd, Las Vegas, NV

License number
Nevada 9669
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: DR. KATHLEEN T. WAGNER M.D.
Title: MEDICAL DIRECTOR
Phone: (702) 364-9988
Address
Address
3120 S Rainbow Blvd SUITE 202, Las Vegas, NV 89146
National Provider ID: 1932379344
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Kathleen T. Wagner, M.D., Professional Corporation

Las Vegas, NV

Status:
Inactive
Registration:
Aug 22, 2003
Addresses:
3120 S Rainbow Blvd, Las Vegas, NV 89146
PO Box 81348, Las Vegas, NV 89180
State ID:
C20435-2003
Business type:
Domestic Professional Corporation
Director, President, Secretary, Treasurer:
Kathleen T. Wagner Director, President, Secretary, Treasurer, inactive
Agent:
Boyce & Gianni, Llp

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