Individual
SHANNON M WAGENMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
17 N MILES AVE, HARDIN, MT 59034-2323
(406) 665-2310
Mailing address
17 N MILES AVE, HARDIN, MT 59034-2323
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0990549
CO
363LF0000X
Family Nurse Practitioner
Primary
100410
MT
363LF0000X
Family Nurse Practitioner
NUR-RN-LIC-71603
MT
Other
Enumeration date
11/19/2013
Last updated
12/03/2015
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