Individual
DANIEL WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8902 N MERIDIAN ST STE 101, INDIANAPOLIS, IN 46260-5306
(317) 848-8048
Mailing address
PO BOX 637764, CINCINNATI, OH 45263-7764
(317) 880-3939
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71011659A
IN
363LF0000X
Family Nurse Practitioner
Primary
28226050A
IN
Other
Enumeration date
09/07/2021
Last updated
10/02/2025
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