MS. DARA MARIE WAGNER (NPI# 1063046464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063046464 |
| Entity Type | Individual |
| Full Name | MS. DARA MARIE WAGNER |
| Credential | APN-C |
| Practice Address |
210 W Walnut St Canton IL 61520-2444 |
| Practice Telephone | 3096475240 |
| Mailing Telephone | 3096475240 |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-04-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209020976 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
210 W WALNUT ST |
| City | CANTON |
| State | IL |
| Zip Code | 61520-2444 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376540559 | Andrew Roudebush | Family Medicine | 210 W Walnut St, Canton, IL 61520-2444 | 2005-07-04 |
| 1235699893 | Christina Willey | Occupational Therapist | 210 W Walnut St, Canton, IL 61520-2444 | 2019-03-20 |
| 1487174744 | Joshua J Wilkinson | Nurse Practitioner | 210 W Walnut St, Canton, IL 61520-2444 | 2017-06-27 |
| 1124482252 | Ryan Deushane | Nurse Anesthetist, Certified Registered | 210 W Walnut St, Canton, IL 61520 | 2016-04-05 |
| 1790143683 | Midwest Mobile Anesthesia Consultants, Sc | Nurse Anesthetist, Certified Registered | 210 W Walnut St, Canton, IL 61520-2444 | 2016-02-05 |
| 1750749826 | Shawn Michael Wynn | Nurse Anesthetist, Certified Registered | 210 W Walnut St, Canton, IL 61520 | 2016-02-04 |
| 1417312232 | Danielle Marianna Sausaman | Dietitian, Registered | 210 W Walnut St, Graham Hospital Food and Nutrition Services, Canton, IL 61520 | 2015-12-21 |
| 1932530938 | Amy Sammis | Dietitian, Registered | 210 W Walnut St, Canton, IL 61520-2444 | 2013-12-02 |
| 1609111988 | William Severt | Physical Therapist | 210 W Walnut St, Canton, IL 61520-2444 | 2012-11-28 |
| 1437448578 | Sandra Anne Haws | Dietitian, Registered | 210 W Walnut St, Canton, IL 61520-2444 | 2011-03-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497978480 | Walton Cs-xi P.C. | Chiropractor | 410 E. Elm Street, Canton, IL 61520 | 2007-04-10 |
| 1811912918 | Jennifer Christine Daniel-price | Chiropractor | 410 E Elm Street, Canton, IL 61520 | 2006-07-12 |
| 1245216241 | Fulton County Health Department | Clinic/Center | 700 East Oak Street, Canton, IL 61520 | 2005-12-21 |
| 1740533835 | Abby L. Sherwood | Chiropractor | 410 E Elm Street, Canton, IL 61520 | 2012-10-26 |
| 1417261041 | Erin Kathleen Buckley | Obstetrics & Gynecology | 180 S Main St, Canton, IL 61520 | 2010-08-06 |
| 1619375532 | Brittany Nicole Miller | Nurse Practitioner | 1300 E Locust St, Canton, IL 61520-0008 | 2014-12-09 |
| 1437197845 | Heartland of Canton Il LLC | Clinic/Center | 2081 N Main St, Canton, IL 61520-1032 | 2006-06-04 |
| 1568063428 | Mary J Eberle | Pharmacist | 2071 N Main St, Canton, IL 61520-1032 | 2020-11-05 |
| 1659970267 | Amanda Sue Kinne | Pharmacist | 2071 N Main St, Canton, IL 61520-1032 | 2020-10-23 |
| 1952879132 | Loft Rehabilitation and Nursing of Canton LLC | Skilled Nursing Facility | 2081 N Main St, Canton, IL 61520-1032 | 2018-11-06 |
| Find all providers in zip 61520 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548875081 | Mohamed Jamal | Nurse Practitioner | 48485 River Way Dr, Canton, MI 48187-5622 | 2020-09-11 |
| 1851906713 | Anishaben Sheth | Nurse Practitioner | 46882 Torrey Hill Ct, Canton, MI 48187-4885 | 2020-09-08 |
| 1184240251 | Timothy John Mcginnis | Nurse Practitioner | 755 Stonehenge Dr, Canton, MI 48188-1257 | 2020-06-24 |
| 1952927477 | Alexandra Arzenshek | Nurse Practitioner | 1042 Creek Side Dr, Canton, GA 30115-8541 | 2020-06-20 |
| 1326663717 | Meghan Markham | Nurse Practitioner | 111 Mountain Brook Dr Ste 100, Canton, GA 30115-9045 | 2020-06-11 |
| 1194348821 | Janet L Jarrette | Nurse Practitioner | 100 Generals Pl, Canton, GA 30114-5881 | 2020-05-28 |
| 1326685124 | Cicely Lashay Scott | Nurse Practitioner | 208 Winterbury Dr, Canton, GA 30114-1235 | 2019-11-30 |
| 1609410976 | Ashley N Decraene | Nurse Practitioner | 50153 Grant St, Canton, MI 48188-3480 | 2019-10-30 |
| 1194369587 | Lori Pulliam | Nurse Practitioner | 470 Northside Cherokee Blvd Ste 250, Canton, GA 30115-8015 | 2019-10-30 |
| 1437719192 | Ebone' Sade' Singleton | Nurse Practitioner | 124 Links Dr Apt 204k, Canton, MS 39046-5388 | 2019-06-15 |
| Find all providers in CANTON | ||||
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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.