Individual
AMY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
940 E 8TH ST, TRAVERSE CITY, MI 49686-2893
(231) 922-4810
(231) 929-0416
Mailing address
415 CASS ST, SUITE 2A & 2D, TRAVERSE CITY, MI 49684-2589
(231) 922-4810
(231) 943-2590
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704231069
MI
163WC0400X
Case Management Registered Nurse
4704231069
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184087272
—
MI
05
—
1629431713
—
MI
Enumeration date
04/21/2016
Last updated
04/21/2016
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