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Individual

SHANA L WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, FNP-BC

Contact information

Practice address
W2850 STATE ROAD 28, SHEBOYGAN FALLS, WI 53085-2702
(920) 467-1800
(920) 467-1900
Mailing address
W2850 STATE ROAD 28, SHEBOYGAN FALLS, WI 53085-2702
(920) 467-1800
(920) 467-1900

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
142621
WI
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
4381
WI
363LF0000X
Family Nurse Practitioner
Primary
4381
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100014290
WI
Enumeration date
02/18/2011
Last updated
01/03/2025
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