Individual
MR. ANTHONY MARK WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
210 SIMMONS ST, MARYVILLE, TN 37801
(865) 970-9800
(865) 983-4518
Mailing address
1400 CENTERPOINT BLVD STE 158, KNOXVILLE, TN 37932-1966
(865) 374-5806
(865) 374-9004
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
11134
TN
363LF0000X
Family Nurse Practitioner
RN129889 NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514002
—
TN
Enumeration date
12/27/2006
Last updated
05/29/2018
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