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General NPI Number Information
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NPI Number | 1710090428
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Entity Type | Individual
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Provider Name | MONTE WAGNER NP
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 8 DELAY ST
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City | DANBURY
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State | CT
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Zip | 06810-6654
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Country | US
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Telephone | 203-797-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CORNWALL DR
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City | NEW MILFORD
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State | CT
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Zip | 06776-5305
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Country | US
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Telephone | 860-210-8098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F333996
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License Number State | NY
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