| Doctor Name: | SHANNON M WAGENMAN |
| NPI Number: | 1013347665 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | NUR-RN-LIC-71603 |
| Business Practice Address: | 17 N Miles Ave Hardin, MT - 590342323 |
| Business Phone Number: | 4066652310 |
| Business Fax Number: | |
| Mailing Address: | 17 N Miles Ave, HARDIN |
| State: | MT |
| Postal Code: | 590342323 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2013 |
| NPI Last Update Date: | 12/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NUR-RN-LIC-71603 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |