Individual
MS. DARA MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN-C
Contact information
Practice address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209020976
IL
363LF0000X
Family Nurse Practitioner
Primary
209020976
IL
Other
Enumeration date
02/25/2020
Last updated
10/20/2021
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