DR. JEFFREY DAVID WAGNER (NPI# 1023552114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023552114 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY DAVID WAGNER |
| Credential | DNP, ARNP |
| Practice Address |
3303 Sw Bond Ave Portland OR 97239 |
| Mailing Address |
3303 Sw Bond Ave Portland OR 97239-4501 |
| Practice Telephone | 5034189400 |
| Practice Fax Number | 5034189401 |
| Mailing Telephone | 5034189400 |
| Mailing Fax Number | 5034189401 |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2018-09-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201801605NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881151876 | Jeffrey Frank Wagner | Pharmacist | 6310 Health Park Way Ste 130, Lakewood Ranch, FL 34202-5177 | 2019-02-26 |
| 1760521843 | Jeffrey M Wagner | Psychologist | 500 Market Street 1-g, Portsmouth, NH 03801 | 2007-02-06 |
| 1437244050 | Jeffrey Todd Wagner | Physical Therapist | 1 Gateway Drive, Wading River, NY 11792 | 2006-10-03 |
| 1891744967 | Jeffrey Douglas Wagner | Physician Assistant | 18 Ronald Ln, Sayville, NY 11782-1622 | 2006-05-08 |
| 1881684207 | Jeffrey M Wagner | Allergy & Immunology | 98 Willow Ln, Spartanburg, SC 29307-1357 | 2005-10-26 |
| 1881690790 | Jeffrey David Wagner | Surgery | 8040 Clearvista Pkwy, Ste 570, Indianapolis, IN 46256 | 2005-06-24 |
| 1255894481 | Jeffrey Ryan Wagner | Student in an Organized Health Care Education/Training Program | 2425 Geary Blvd, San Francisco, CA 94115-3358 | 2019-04-14 |
| 1003312117 | Jeffrey Wagner | Clinical Exercise Physiologist | 3525 E Louise Dr, Meridian, ID 83642-6302 | 2018-04-05 |
| 1578798914 | Jeffrey Mark Wagner | Physical Therapist | 1430 Esplanade, Suite 8, Chico, CA 95926-3366 | 2009-05-28 |
| 1568624187 | Jeffrey G Wagner | Family Medicine | 9280 W Sunset Rd Ste 200, Las Vegas, NV 89148 | 2008-06-25 |
| Street Address |
3303 SW BOND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639174287 | Dawn F. Tilgner | Nurse Practitioner | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2005-06-19 |
| 1376164582 | Marisa Palandri | Occupational Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-28 |
| 1194345629 | Margaret Alva Mcreynolds | Physical Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-24 |
| 1104446392 | Jennifer Crawford | Occupational Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-17 |
| 1093335275 | Mehak Noorani | Speech-Language Pathologist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-17 |
| 1497374185 | Ruth Semon | Physical Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-13 |
| 1649899675 | Kristin Moore | Physical Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-09 |
| 1821627266 | Mollie Ann Suits | Physical Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-07 |
| 1801425269 | Andrea Susan Serdar | Physical Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-06 |
| 1508495037 | Chante Noel Larlee | Physical Therapist | 3303 Sw Bond Ave, Portland, OR 97239-4501 | 2020-04-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558979468 | Elise Caitlin Esposito | Student in an Organized Health Care Education/Training Program | 3710 Sw U.S. Veterans Hospital Road, Dental Service P-3 Dent, Attn: Elise Esposito, Portland, OR 97239 | 2020-07-16 |
| 1750908844 | Will Cowan | Student in an Organized Health Care Education/Training Program | 455 Sw Us Veterans Hospital Road., Portland, OR 97239 | 2020-07-06 |
| 1881219657 | Desiree Baer | Licensed Vocational Nurse | Sw Us Veterans Hospital Rd, Portland, OR 97239 | 2020-06-08 |
| 1285266205 | Melissa Irene Wheeler | Registered Nurse | Uhs-8l, 3181 S.w. Sam Jackson Park Road, Portland, OR 97239 | 2020-02-07 |
| 1225687981 | Pheba Mariam Jones | Pharmacist | Ohsu Pharmacy At Chh Building 2, 3303 Sw Bond Ave Rm 1090, Portland, OR 97239 | 2019-09-05 |
| 1801448063 | Alice Huang Huang | Student in an Organized Health Care Education/Training Program | 3710 Sw Veterans Road, Portland, OR 97239 | 2019-07-09 |
| 1710446273 | Ellen Noreen Kessi | Social Worker | 3710 Sw Us Veterans Rd., Portland, OR 97239 | 2019-03-14 |
| 1508335704 | Jacqueline Marie Mular | Marriage & Family Therapist | 5550 Sw Macadam Suite 100, Portland, OR 97239 | 2018-11-16 |
| 1275030926 | Carly Elizabeth Dougher | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd., Portland, OR 97239 | 2018-04-10 |
| 1780188094 | Dennis John Samuel | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd. L-579, Portland, OR 97239 | 2018-03-21 |
| Find all providers in zip 97239 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043822794 | Danielle Langer | Nurse Practitioner | 35 Ridgeview Rd, Portland, CT 06480-4014 | 2020-08-23 |
| 1508476250 | Harrington Health Clinic | Nurse Practitioner | 310 Nw Glisan Street, Portland, OR 97209 | 2020-08-07 |
| 1114566650 | Sadie Garnache-poirier | Nurse Practitioner | 65 W Commercial St Ste 107, Portland, ME 04101-4789 | 2020-01-02 |
| 1902441629 | Jennifer Marie Colpitts | Nurse Practitioner | 1600 Congress St Ste B, Portland, ME 04102-2148 | 2019-11-18 |
| 1477102689 | Raquel A Bishop | Nurse Practitioner | 12400 Nw Cornell Rd Ste 100, Portland, OR 97229 | 2019-09-10 |
| 1265081640 | Christina Lee | Nurse Practitioner | 144 State St # 1, Portland, ME 04101-3776 | 2019-09-09 |
| 1407401474 | Abby Christine Vopal | Nurse Practitioner | 66 Bramhall St Fl 1, Portland, ME 04102-3355 | 2019-08-07 |
| 1770145294 | Cynthia Marie Martinez | Nurse Practitioner | 1145 Austin St, Portland, TX 78374-2013 | 2019-07-04 |
| 1528532306 | Matthew James Keelin | Nurse Practitioner | 6801 Ne Cornfoot Rd, Portland, OR 97218-2743 | 2019-01-15 |
| 1659847580 | Colleen Jeanette Scott | Nurse Practitioner | 650 Nw Irving St, Portland, OR 97209-1272 | 2018-10-18 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.