Individual
ANNA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3845 W 4700 S, TAYLORSVILLE, UT 84129-3454
(801) 840-2170
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10756382-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10756382-3102
UTAH DOPL
UT
Enumeration date
07/29/2020
Last updated
01/29/2026
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