License holder summary

Mary Dizer Wagner is a Medical - Physician And Surgeon licensed to practice in Minnesota. The address on file for Mary Dizer Wagner is Park Nicollet Clinic, 6600 Excelsior Blvd--160, St. Louis Park, MN 55426. This doctor license is current. The license was granted 09/11/1993 and expired on 11/30/2014.

Department of Safety and Professional Services

Board of Medical Practice

Mary Dizer Wagner
Medical - Physician And Surgeon
License number
36748
Date granted
09/11/1993
Date expires
11/30/2014
Class
Medical - Physician And Surgeon
Status
Active
Address
Park Nicollet Clinic, 6600 Excelsior Blvd--160, St. Louis Park, MN 55426
doctorsminnesota.org
ID 22326318
LAST UPDATED 2024-02-26 14:04:51 UTC

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