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Individual
SANDRA M WAGNER
Active
Individual
SANDRA M WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
617-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2292
DEAN HEALTH INSURANCE
WI
05
—
42935000
—
WI
Enumeration date
06/23/2006
Last updated
03/06/2019
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