Individual
BRADLEY THOMAS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
611 SHERMAN AVE E, FORT ATKINSON, WI 53538-1960
(920) 568-5000
Mailing address
PO BOX 249, FORT ATKINSON, WI 53538-0249
(920) 563-4466
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
190070-30
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
190070-30
WI
Other
Enumeration date
01/26/2012
Last updated
12/19/2025
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