Individual
STEPHANIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
77 BAYVIEW ST, BELFAST, ME 04915-6709
(207) 338-6120
Mailing address
77 BAYVIEW ST, BELFAST, ME 04915-6709
(207) 338-6120
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
CNP101001
ME
363LF0000X
Family Nurse Practitioner
Primary
AP101001
ME
Other
Enumeration date
01/25/2013
Last updated
10/22/2015
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