Individual
MS. NICOLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
431 W LIBERTY ST, WAUCONDA, IL 60084-2452
(847) 526-2151
(847) 526-2017
Mailing address
PO BOX 6037, WAUCONDA, IL 60084
(847) 526-2151
(847) 526-2017
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209004749
IL
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
209004749
IL
Other
Enumeration date
04/14/2009
Last updated
06/24/2019
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