Individual
LUCAS M. WANGERIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1650 COCHRANE CIR # B7500, FORT CARSON, CO 80913-4604
(719) 524-7219
Mailing address
6382 SAN MATEO DR, COLORADO SPRINGS, CO 80911-4015
(785) 226-2322
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0007051
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA.0007051
—
CO
Enumeration date
02/09/2012
Last updated
01/26/2022
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