Individual
MRS. MICHELLE JAYNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
248 MCHENRY ST, BURLINGTON, WI 53105-1828
(262) 767-8000
Mailing address
248 MCHENRY ST, BURLINGTON, WI 53105-1828
(262) 767-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56951
WI
Other
Enumeration date
04/13/2010
Last updated
12/06/2021
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