Individual
LOIS WAGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
(574) 307-7692
Mailing address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
(574) 307-7692
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005871A
IN
Other
Enumeration date
10/15/2015
Last updated
07/06/2021
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