Individual
ANGELA D WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4023
(701) 234-4050
Mailing address
2401 41ST ST S, STE 101, FARGO, ND 58104-7783
(701) 234-4023
(701) 234-4050
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC0344
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186186700
—
MN
05
—
71059
—
ND
Enumeration date
07/18/2006
Last updated
01/25/2022
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