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Individual
MICHAEL DAVID WAGNER
Active
Individual
MICHAEL DAVID WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, RN, CNP, PMHNPBC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
191995-4
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
7558
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R247240
MD
Other
Enumeration date
07/23/2020
Last updated
08/25/2025
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