Lianne Rose Wagner, DO
Student in an Organized Health Care Education/Training Program in Detroit, MI. Individual provider (NPI-1).
NPI number1871237602
StatusActive
Last updated in NPPESJun 13, 2022
Details
- NPI
- 1871237602
- Entity type
- Individual (NPI-1)
- Name
- Lianne Rose Wagner
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 27, 2022
- Certification date
- Jun 13, 2022
- Last updated
- Jun 13, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
22101 Moross Rd Ste 214Detroit, MI 48236-2148
Phone 313-343-7110
Mailing address
22101 Moross Rd Ste 214Detroit, MI 48236-2148
Phone 586-576-4345
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