Individual
COURTNEY LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
2105 E ENTERPRISE AVE # 113, APPLETON, WI 54913-7862
(920) 991-2561
Mailing address
N7898 LAKESHORE DR, FOND DU LAC, WI 54937-1647
(920) 517-6961
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1890-39
WI
Other
Enumeration date
05/07/2019
Last updated
10/13/2024
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