Individual
LIANNE ROSE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
22101 MOROSS RD STE 214, DETROIT, MI 48236-2148
(313) 343-7110
Mailing address
22101 MOROSS RD STE 214, DETROIT, MI 48236-2148
(586) 576-4345
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/27/2022
Last updated
06/13/2022
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