Search › Missouri › 363LF0000X
Traci Wagoner
NPI 1568715712 · on the registry since 2012
Practice
- Address
- 2424 Zumbehl Rd
Saint Charles, MO 63301 - Phone
- (636) 443-4202
- Fax
- (636) 277-7386
- Organisation at this address
- Premise Health Of Missouri Medical Pc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Licence states on file
- MO
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-03-25
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Missouri