DIANA WAGNER MD (Credential# 1005523) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
DIANA WAGNER MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0050633. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 460 Hartford Tpke Ste A, Vernon Rockville, CT 06066-4847. The current status is active.
| Licensee Name | DIANA WAGNER MD |
| Credential ID | 1005523 |
| Credential Number | CSP.0050633 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
460 Hartford Tpke Ste A Vernon Rockville CT 06066-4847 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2011-07-19 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-02-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1003396 | 1.050129 | Physician/Surgeon | 2011-07-14 | 2019-08-01 - 2020-07-31 | ACTIVE |
| Street Address | 460 HARTFORD TPKE STE A |
| City | VERNON ROCKVILLE |
| State | CT |
| Zip Code | 06066-4847 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Vernon Dialysis Center | 460 Hartford Tpke Ste C, Vernon, CT 06066-4847 | Hemodialysis | 2018-07-01 ~ 2020-06-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Cynthia Stelma | 35 White St, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Diana C Mendieta | 127 Lake St, Vernon, CT 06066 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-26 ~ 2022-02-28 |
| Taylor Rose Mulcahy | 95 Hockanum Blvd Unit #5223, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Eric Scott · E Scott Const | 27 Lawrence St, Vernon Rockville, CT 06066 | Home Improvement Contractor | 2020-06-20 ~ 2020-11-30 |
| Margaret A Lucerini | 27 Rosewood Dr, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Alexander John Bozzi | 28 Deepwood Dr, Vernon, CT 06066 | Home Inspector Intern | 2020-05-30 ~ 2021-06-30 |
| Kathleen N Laplaca | 244 Risley Road, Vernon, CT 06066 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Shawnda Shelton | 215 East Main St. #25, Vernon, CT 06066 | Medication Administration Certification | 2020-06-05 ~ 2022-06-04 |
| Ireland Oil Co Inc | 171 Union St, Vernon, CT 06066 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Annmarie Margaret Fultz | 1a Prospect St, Vernon Rockville, CT 06066 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Find all Licenses in zip 06066 | |||
| City | VERNON ROCKVILLE |
| Zip Code | 06066 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + VERNON ROCKVILLE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Brian K Wagner | 11 South Rd, Farmington, CT 06032-2483 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Thomas J Wagner | 540 Route 148, Killingworth, CT 06419 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Jessica L Wagner | 227 Church St Apt 7c, New Haven, CT 06510 | Controlled Substance Registration for Practitioner | 2009-03-01 ~ 2011-02-28 |
| Krystn R Wagner | 374 Grand Ave, New Haven, CT 06513-3733 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Annette V Wagner Md | 7 Niagara Pier, Erie, PA 16507 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| James L. Wagner | 1608 Riverview Rd, Chattanooga, TN 37405-3131 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Peter John Wagner | 162 Dawley Dr., Stonington, CT 06378 | Controlled Substance Registration for Practitioner | 2019-04-02 ~ 2021-02-28 |
| Cliff Wagner Md | 161 Talcott Notch Rd, Farmington, CT 06032 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Matthew P Wagner | 1450 Chapel St, New Haven, CT 06511-4405 | Controlled Substance Registration for Practitioner | 2011-03-01 ~ 2013-02-28 |
| Joseph R Wagner Md | 85 Seymour St Suite 416, Hartford, CT 06106 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
Please comment or provide details below to improve the information on DIANA WAGNER MD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).