Individual
SHY L WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
2921 MONTVALE DR, SPRINGFIELD, IL 62704-5359
(217) 787-2700
(217) 787-2715
Mailing address
2921 MONTVALE DR, SPRINGFIELD, IL 62704-5359
(217) 787-2700
(217) 787-2715
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Enumeration date
09/02/2009
Last updated
02/17/2012
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