NPI 1184895070

Marie a Wagner

Practitioner Contractor Port Saint Lucie, FL

Practice location

Address: 365 SW Log Dr, Port Saint Lucie, FL 34953-7501
Phone: (772) 785-6473
Fax: (772) 408-0998

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 19-3549-004-08 (FL)

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Registry record

NPI: 1184895070
Entity type: Individual
Sex (as registered): Female
NPI issued: 18 Mar 2008
Record last updated: 18 Mar 2008

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.