Individual
HEIDI WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
545 PLAINFIELD RD STE G-1, WILLOWBROOK, IL 60527-7600
(708) 405-8025
(763) 205-9350
Mailing address
545 PLAINFIELD RD STE G-1, WILLOWBROOK, IL 60527-7600
(630) 205-0101
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209014217
IL
Other
Enumeration date
10/28/2016
Last updated
01/31/2024
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