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1548413925
SHANE L WAGNER
FORT SMITH, AR
NPI
1548413925
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2008-10-29
Last Update Date
2024-03-06
Business Address
SHANE L WAGNER MHPP
3111 S 70TH ST
FORT SMITH, AR 72903-5017
Phone number: 479-452-6650
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Mailing Address
SHANE L WAGNER MHPP
3111 S 70TH ST
FORT SMITH, AR 72903-5017
Phone number: 479-452-6650
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