Individual
NATHANAEL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5242 PLAINFIELD AVE NE STE C, GRAND RAPIDS, MI 49525-1084
(616) 481-7106
Mailing address
1157 TREEWAY NW, SPARTA, MI 49345-8240
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401010643
MI
Other
Enumeration date
06/21/2018
Last updated
06/21/2018
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