Individual
KIMBERLY ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6480 TECHNOLOGY AVE, KALAMAZOO, MI 49009-8119
(877) 385-0535
(269) 250-8020
Mailing address
22401 HAPPY DR, CASSOPOLIS, MI 49031-9700
(574) 238-5500
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704315041
MI
Other
Enumeration date
06/02/2020
Last updated
06/02/2020
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