Individual
MS. VIRGINIA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC EMERGENCY MEDICINE, MILWAUKEE, WI 53226-4874
(414) 266-2625
(414) 266-2635
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC EMERGENCY MEDICINE, MILWAUKEE, WI 53226-4874
(414) 266-2625
(414) 266-2635
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
238-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009006261D
HUMANA
—
05
—
1124074315
—
WI
Enumeration date
05/26/2006
Last updated
10/06/2014
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