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1366419087
CAROLYN WAGNER
DECATUR, IL
NPI
1366419087
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: IL 209-001389)
Enumeration Date
2006-03-01
Last Update Date
2011-03-10
Business Address
Mrs. CAROLYN WAGNER NP
1770 E LAKE SHORE DR SUITE 207
DECATUR, IL 62521-3832
Phone number: 217-429-9700
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Mailing Address
Mrs. CAROLYN WAGNER NP
1770 E LAKE SHORE DR SUITE 207
DECATUR, IL 62521-3832
Phone number: 217-429-9700
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