# NICOLE ANN WAGAMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1689011405
- **Gender:** F
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | DO-05546 | IA | Yes |

## Other

- **Enumeration date:** 06/03/2013
- **Last updated:** 08/13/2024