ERIC DAVID WAGNER

CARBONDALE, IL
NPI1306358445
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: IL  209016825)
Enumeration Date2017-10-30
Last Update Date2021-03-05
Business Address
ERIC DAVID WAGNER
405 W JACKSON ST
CARBONDALE, IL 62901-1462
Phone number: 618-549-0721
Mailing Address
ERIC DAVID WAGNER
PO BOX 3988
CARBONDALE, IL 62902-3988
Phone number: 618-457-5200
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