Individual
SHANNON MICHELLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
551 BROADWAY, EAGLE, CO 81631
(970) 328-8840
(855) 848-8829
Mailing address
PO BOX 660, EAGLE, CO 81631-0660
(970) 328-8840
(855) 848-8829
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1625641
CO
Other
Enumeration date
06/12/2020
Last updated
06/12/2020
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