Individual
MS. MELISSA SUE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
8100 NORTHLAND DR, BLOOMINGTON, MN 55431-4800
(952) 831-8742
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3805
MN
363LA2100X
Acute Care Nurse Practitioner
2010012196
MO
Other
Enumeration date
06/21/2010
Last updated
06/13/2023
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