Individual
MRS. DEBORAH A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4032
Mailing address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4032
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
140806
MN
363A00000X
Physician Assistant
2099
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41936300
—
WI
Enumeration date
02/28/2007
Last updated
07/14/2022
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