NPI 1053039016

Nolan Wagner, LAT

Practitioner Athletic Trainer Green Bay, WI

Practice location

Address: 1970 S Ridge Rd, Green Bay, WI 54304-4125
Phone: (920) 430-4888
Mailing address: 6700 County Road J, Sturgeon Bay, WI 54235-9336

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 2289-39 (WI)

Other Specialist/Technologist providers in Wisconsin →

Registry record

NPI: 1053039016
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Aug 2022
Record last updated: 16 Aug 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.