Individual
PAUL MICHAEL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 W LYNTHUR LN, SANFORD, MI 48657-9318
(989) 488-7835
Mailing address
515 W LYNTHUR LN, SANFORD, MI 48657-9318
(989) 488-7835
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704345086
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4704345086
—
MI
Enumeration date
03/01/2023
Last updated
03/01/2023
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