Individual
ERIK W WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
F.N.P.
Contact information
Practice address
4838 E. BASELINE RD., BLDG 2, SUITE 109, MESA, AZ 85206-4677
(480) 969-4040
(480) 830-1042
Mailing address
4824 E BASELINE RD, SUITE 110, MESA, AZ 85206-4676
(480) 969-4040
(480) 830-1042
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP4826
AZ
363LF0000X
Family Nurse Practitioner
TAP4826
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
825839
—
AZ
01
—
Z233314
MEDICARE PTAN
AZ
Enumeration date
08/09/2006
Last updated
11/21/2019
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