Individual
DIANE JUNE WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
28400 PLACE ST, ROCKWOOD, MI 48173-9734
(734) 771-6635
Mailing address
28400 PLACE ST, ROCKWOOD, MI 48173-9734
(734) 771-6635
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
MI
Other
Enumeration date
03/16/2026
Last updated
03/16/2026
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