Individual
DONNA K WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
550 UNIVERSITY BLVD, UH 4100, INDIANAPOLIS, IN 46202-5149
(317) 944-8660
Mailing address
PO BOX 44994, INDIANAPOLIS, IN 46244-0994
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001189
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200368080
—
IN
Enumeration date
05/01/2006
Last updated
11/03/2011
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