Individual
MS. JUDITH LYNN WAGENSOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-1545
Mailing address
3388 RIVERSIDE DR, CANTON, MI 48188-2337
(734) 495-1232
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002034
MI
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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