Mary D Wagner

NPI #1093792822 in St Louis Park, Minnesota

Provider Information

NPI Number: 1093792822
Entity Type: Individual
Name: Mary D Wagner
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Enumeration Date: Dec 22, 2005
Last Updated: Mar 8, 2012

Practice Location

Address: 6600 EXCELSIOR BLVD
Address 2: STE 160
City: St Louis Park
State: Minnesota
ZIP Code: 55426-4744
Phone: (952) 993-7707

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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