Individual
ELIZABETH A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-3640
(920) 445-7289
Mailing address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-3640
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
125165-30
WI
363LF0000X
Family Nurse Practitioner
Primary
4106-33
WI
Other
Enumeration date
07/01/2010
Last updated
02/20/2015
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