Provider Demographics
NPI:1043080492
Name:WAGNON, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WAGNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:WRIGHT
Mailing Address - State:WY
Mailing Address - Zip Code:82732-1012
Mailing Address - Country:US
Mailing Address - Phone:307-267-5370
Mailing Address - Fax:
Practice Address - Street 1:411 SAND CREEK CIR
Practice Address - Street 2:
Practice Address - City:WRIGHT
Practice Address - State:WY
Practice Address - Zip Code:82732-5081
Practice Address - Country:US
Practice Address - Phone:307-267-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health