Individual
MARIE BROWN-WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
131753-2
NY
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
50773
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022392
KAISER COMMERCIAL NUMBER
CO
05
—
23083336
—
CO
05
—
621830
—
AZ
05
—
G7888
—
NM
Enumeration date
08/21/2006
Last updated
02/02/2012
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