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Individual

ERIC WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
526 W MAIN ST, SPARTA, WI 54656-2146
(608) 387-3586
Mailing address
526 W MAIN ST, SPARTA, WI 54656-2146
(608) 387-3586

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309254-031
WI

Other

Enumeration date
01/19/2015
Last updated
01/19/2015
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