Individual
PHILIP A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8990 SPRINGBROOK DR NW, SUITE 250, COON RAPIDS, MN 55433-5850
(763) 398-1162
(763) 398-0124
Mailing address
1200 LINCOLN AVE, SAINT PAUL, MN 55105-2737
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 147759-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
627620200
—
MN
01
—
676G4WA
BCBSMN
MN
Enumeration date
09/14/2005
Last updated
05/16/2008
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