Individual
DAYLEN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
347 S GLADSTONE AVE, AURORA, IL 60506-4877
(630) 892-6431
Mailing address
1928 IRON MOUNTAIN DR, FESTUS, MO 63028-3166
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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