Organization
ROOT FUNCTION WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY WAGONER MD (MEMBER)
(605) 880-0679
Entity
Organization
Contact information
Practice address
2320 9TH AVE SE, WATERTOWN, SD 57201-7112
(605) 753-0920
Mailing address
6554 9TH AVE SW, WATERTOWN, SD 57201-7099
(605) 880-0679
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376554568
—
SD
Enumeration date
11/26/2018
Last updated
11/26/2018
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