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NPI Code Detail

MEDICARE: ANDREA LOUISE WAGNER MED

MEDICARE:   ANDREA LOUISE WAGNER  MED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor02206MN

General Provider Information

NPI Number : 1265049779
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LOUISE WAGNER MED
Provider Business Mailing Address
First Line : 1538 3RD AVE SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-3823
Country : US
Telephone Number : 507-884-1497
Fax Number :
Provider Business Practice Location Address
First Line : 1052 OAK FOREST DR STE 190
Second Line :
City : ONALASKA
State : WI
Zip : 54650-3705
Country : US
Telephone Number : 507-884-1497
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2020
Last Update Date : 04/07/2026

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Directions to “ ANDREA LOUISE WAGNER MED” Practice Location

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