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1245065846
NICHOLAAS COLLIN WAGNER
FORT CAMPBELL, KY
NPI
1245065846
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
Enumeration Date
2024-09-04
Last Update Date
2024-09-04
Business Address
NICHOLAAS COLLIN WAGNER PA-S
650 JOEL DR
FORT CAMPBELL, KY 42223-5318
Phone number: 210-620-0085
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Mailing Address
NICHOLAAS COLLIN WAGNER PA-S
492 AYDEN LN
CLARKSVILLE, TN 37042-2887
Phone number: 210-620-0085
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