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1053039016
NOLAN WAGNER
GREEN BAY, WI
NPI
1053039016
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: WI 2289-39)
Enumeration Date
2022-08-16
Last Update Date
2022-08-16
Business Address
NOLAN WAGNER LAT
1970 S RIDGE RD
GREEN BAY, WI 54304-4125
Phone number: 920-430-4888
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Mailing Address
NOLAN WAGNER LAT
6700 COUNTY ROAD J
STURGEON BAY, WI 54235-9336
Phone number: 920-495-3052
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