Individual
CRAIG A WAGAMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
206 8TH ST NW, VALLEY CITY, ND 58072
(701) 550-9335
Mailing address
206 8TH ST NW, VALLEY CITY, ND 58072
(701) 550-9335
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R29587
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13462
—
ND
05
—
1649332461
—
WI
01
—
25761
BLUE CROSS BLUE SHIELD
ND
Enumeration date
12/15/2006
Last updated
07/03/2013
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