Individual
SHANE WAGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5138 N JULIANO RD, LAS VEGAS, NV 89149-4110
(702) 348-5547
Mailing address
5138 NORTH JULIANO ROAD, LAS VEGAS, NV 89149
(702) 348-5547
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/28/2015
Last updated
07/28/2015
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