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Individual

MICHAEL DAVID WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MS, RN, CNP, PMHNPBC

Contact information

Practice address
13719 LAPWING WAY, CLARKSBURG, MD 20871-3401
(507) 696-2157
Mailing address
13719 LAPWING WAY, CLARKSBURG, MD 20871-3401
(507) 696-2157

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
191995-4
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
7558
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R247240
MD

Other

Enumeration date
07/23/2020
Last updated
08/25/2025
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