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1073655825
MICHAEL C WAGNER
DANVILLE, IL
NPI
1073655825
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: IL 209003483)
Enumeration Date
2007-02-12
Last Update Date
2010-11-17
Business Address
-- MICHAEL C WAGNER FNP
603 N LOGAN AVE
DANVILLE, IL 61832-4320
Phone number: 217-213-5254
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Mailing Address
-- MICHAEL C WAGNER FNP
603 N LOGAN AVE
DANVILLE, IL 61832-4320
Phone number: 217-213-5254
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