MARIAH MARIE WAGNER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007649

License Status

ACTIVE

Business

First Name

MARIAH

Middle

MARIE

Last Name

WAGNER

Business Name

MARIAH MARIE WAGNER

Original Issue Date

05/12/2020

Effective Date

01/06/2026

Expiration Date

03/01/2028

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

01/06/2026