Individual
LYNN K WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
106 N WISCONSIN ST, DE PERE, WI 54115
(920) 327-7056
Mailing address
164 N BROADWAY, GREEN BAY, WI 54303-2728
(920) 490-9046
(920) 405-5388
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
49400
WI
207P00000X
Emergency Medicine Physician
A89772
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104894116
—
MI
05
—
34870800
—
WI
01
—
P00355797
RAILROAD
WI
Enumeration date
06/24/2006
Last updated
05/22/2018
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