Individual
MRS. MELISSA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-5336
Mailing address
1402 BANAVIE TER W, BEL AIR, MD 21015-5780
(410) 838-3275
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
R174093
MD
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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