Individual
ELLEN AFRICANO WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
19624 GOVERNORS HWY, FLOSSMOOR, IL 60422-2077
(708) 798-5838
(708) 798-5865
Mailing address
1713 N VINE ST, CHICAGO, IL 60614-5119
(312) 513-2177
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041372498
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209.012203
IL
Other
Enumeration date
09/24/2014
Last updated
07/21/2022
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