Individual
D'OVIONN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1625 N CAMPBELL AVE STE 8423, TUCSON, AZ 85719-4330
(928) 286-7136
Mailing address
PO BOX 1402, FORT DEFIANCE, AZ 86504-1402
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATR-009586
AZ
Other
Enumeration date
11/08/2023
Last updated
12/06/2023
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