Individual
STACY MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1200 PLEASANT ST, DES MOINES, IA 50309-1406
(515) 241-4497
(515) 241-4405
Mailing address
1200 PLEASANT ST, DES MOINES, IA 50309-1406
(515) 241-4497
(515) 241-4405
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R-8118
IA
Other
Enumeration date
06/14/2007
Last updated
07/08/2007
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