Individual
MS. JONI WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
740 S HILL ST, SALEM, SD 57058-8760
(605) 425-2855
(605) 425-2149
Mailing address
PO BOX 86430, SIOUX FALLS, SD 57118-6430
(605) 322-4900
(605) 322-4925
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0481
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-11971
MEDICA
SD
01
—
234724
MIDLAND'S CHOICE
SD
01
—
2843
AVERA HEALTH
SD
01
—
4997236
WELLMARK
SD
05
—
6823310
—
SD
01
—
9238086
DAKOTACARE
SD
01
—
AH1311029419
PREFERRED ONE
SD
01
—
HP34870
HEALTH PARTNERS
SD
01
—
S1639
MEDICARE PTAN
SD
Enumeration date
01/23/2006
Last updated
12/27/2017
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