Individual
ANDREW JACOB WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RRT-NPS
Contact information
Practice address
500 E VETERANS ST, TOMAH, WI 54660-3105
(608) 372-3971
Mailing address
500 E VETERANS ST, TOMAH, WI 54660-3105
(608) 372-3971
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
—
WI
227900000X
Registered Respiratory Therapist
Primary
122206
WI
2279P3900X
Neonatal/Pediatric Registered Respiratory Therapist
122206
WI
Other
Enumeration date
04/01/2021
Last updated
09/28/2022
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