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1881711224
JUDITH LYNN WAGENSOMER
DETROIT, MI
NPI
1881711224
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: MI 5601002034)
Enumeration Date
2007-03-22
Last Update Date
2007-07-08
Business Address
Ms. JUDITH LYNN WAGENSOMER PA-C
2799 W GRAND BLVD
DETROIT, MI 48202-2608
Phone number: 313-916-1545
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Mailing Address
Ms. JUDITH LYNN WAGENSOMER PA-C
3388 RIVERSIDE DR
CANTON, MI 48188-2337
Phone number: 734-495-1232
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