Individual
MONICA ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4750
(920) 430-4746
Mailing address
8069 COUNTY ROAD A, LENA, WI 54139-9737
(920) 842-3280
(920) 430-4746
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
345039
WI
Other
Enumeration date
09/23/2005
Last updated
07/08/2007
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