Individual
MR. ALAN DUANE WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
Mailing address
35 ALBANY RD, SUITE C, CARBONDALE, IL 62903-7605
(618) 457-5111
(618) 457-6560
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
IL
Other
Enumeration date
08/22/2005
Last updated
07/08/2007
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