Individual
MRS. MICHELE WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1050 W INDUSTRIAL BLVD STE 17, CUMBERLAND, MD 21502-4331
(240) 964-9300
(240) 964-9310
Mailing address
PO BOX 1671, CUMBERLAND, MD 21501-1671
(240) 964-8342
(240) 964-8337
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
65656
WV
363LF0000X
Family Nurse Practitioner
Primary
R144825
MD
Other
Enumeration date
03/23/2007
Last updated
07/27/2020
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