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Individual

ELIZABETH MARIE WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN, MSN, CPNP-AC

Contact information

Practice address
2525 CHICAGO AVE # MS 324203, MINNEAPOLIS, MN 55404-4518
(126) 813-7336
(612) 813-7660
Mailing address
1019 DANUBE AVE, SHAKOPEE, MN 55379-4636
(612) 813-7336
(612) 813-7336

Taxonomy

Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
41272234
IL

Other

Enumeration date
06/14/2006
Last updated
03/13/2023
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