MS. Marie A Wagner

NPI #1184895070 in Port Saint Lucie, Florida

Provider Information

NPI Number: 1184895070
Entity Type: Individual
Name: MS. Marie A Wagner
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Contractor
Enumeration Date: Mar 18, 2008
Last Updated: Mar 18, 2008

Practice Location

Address: 365 SW LOG DR
City: Port Saint Lucie
State: Florida
ZIP Code: 34953-7501
Phone: (772) 785-6473

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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