Individual
AMY J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
52990
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134263619
—
WI
Enumeration date
02/16/2007
Last updated
03/13/2024
Update your record
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