Individual
MRS. KIMBERLY ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 PERRYMAN ST, LEBANON, IL 62254-1356
(618) 537-6165
Mailing address
1 PERRYMAN ST, LEBANON, IL 62254-1356
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.085404
IL
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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