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Individual
NICOLE ANN WAGAMAN
Active
Individual
NICOLE ANN WAGAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R-9752
IA
208100000X
Physical Medicine & Rehabilitation Physician
67461
WI
208100000X
Physical Medicine & Rehabilitation Physician
87896
SC
2081P0004X
Spinal Cord Injury Medicine Physician
331223
LA
2081P0004X
Spinal Cord Injury Medicine Physician
Primary
DO-05546
IA
Other
Enumeration date
06/03/2013
Last updated
08/13/2024
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