Individual
JULIE C WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
501 S WHITE ST, SUITE 1, MT PLEASANT, IA 52641-2600
(319) 385-6700
(319) 385-6703
Mailing address
501 S WHITE ST, SUITE 1, MT PLEASANT, IA 52641-2600
(319) 385-6700
(319) 385-6703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3661
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0451757
—
IA
05
—
2451757
—
IA
Enumeration date
04/14/2006
Last updated
10/12/2007
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