Individual
AVERY WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8805 N MERIDIAN ST, INDIANAPOLIS, IN 46260-2760
(317) 706-7246
(317) 706-3417
Mailing address
29943 NETWORK PL, CHICAGO, IL 60673-1299
(317) 706-3415
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10005243A
IN
Other
Enumeration date
04/15/2026
Last updated
04/15/2026
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