Individual
BLAIR WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 1/2 S 7TH ST., RM 1, RICHMOND, IN 47374
(765) 935-5390
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71014313A
IN
Other
Enumeration date
09/15/2023
Last updated
09/15/2023
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