Individual
DONNA WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
935 HWY V V, KENNETT, MO 63857
(573) 888-0642
(573) 888-8833
Mailing address
935 HIGHWAY V V, KENNETT, MO 63857
(573) 888-0642
(573) 888-8833
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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