Individual
KRISTEN M WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3443 FARR RD, FRUITPORT, MI 49415-8779
(231) 672-2900
(231) 672-2901
Mailing address
1675 LEAHY ST, SUITE 315A, MUSKEGON, MI 49442-5500
(231) 727-5209
(231) 672-2901
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101020125
MI
207V00000X
Obstetrics & Gynecology Physician
5101020125
MI
Other
Enumeration date
10/09/2012
Last updated
12/23/2020
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