Individual
MARY E. WAGMEISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845
(260) 266-5700
(260) 266-5910
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005845A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201332540
—
IN
Enumeration date
03/23/2006
Last updated
10/07/2022
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