Individual
BLAIR WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 MAGNOLIA ST # B, SLIDELL, LA 70460-8821
(504) 400-3896
Mailing address
1501 MAGNOLIA ST # B, SLIDELL, LA 70460-8821
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
009605995
LA
Other
Enumeration date
08/26/2021
Last updated
08/26/2021
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