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Individual

MICHELLE WAGNER-SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, AGPCNP-BC

Contact information

Practice address
JOHN D. DINGELL VAMC, 4646 JOHN R STREET, DETROIT, MI 48201-1916
(313) 576-4645
Mailing address
5780 STEWART RD, MONROE, MI 48162-9700
(734) 915-6265

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4704204786
MI
363LG0600X
Gerontology Nurse Practitioner
4704204786
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704204786
MI

Other

Enumeration date
04/14/2015
Last updated
04/15/2015
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