NICOLE WAGNER (NPI# 1154759033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154759033 |
| Entity Type | Individual |
| Full Name | NICOLE WAGNER |
| Practice Address |
714 W Main St Grass Valley CA 95945 |
| Mailing Address |
714 W. Main St Grass Valley CA 95945 |
| Practice Telephone | 5304779800 |
| Mailing Telephone | 5304779800 |
| Mailing Fax Number | 5304779803 |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2013-10-31 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720353311 | Nicole Wagner | Occupational Therapist | 465 S Lawrence Blvd, Keystone Heights, FL 32656-9222 | 2012-03-14 |
| 1164759882 | Nicole L Wagner | Pharmacist | 6601 Watauga Rd Ste 126, Watauga, TX 76148-3331 | 2009-11-17 |
| 1295803476 | Nicole S Wagner | Psychologist | 29525 Chagrin Blvd Ste 313, Beachwood, OH 44122 | 2006-12-04 |
| 1396353272 | Nicole Wagner | Counselor | 1100 Hospital Dr, Batavia, OH 45103-1920 | 2020-07-16 |
| 1114562097 | Nicole Kristin Wagner | Pharmacist | 17105 San Carlos Blvd, Fort Myers Beach, FL 33931-5305 | 2019-11-14 |
| 1841844925 | Nicole Doris Wagner | Occupational Therapist | 7430 W Commercial Blvd, Lauderhill, FL 33319-2130 | 2019-07-28 |
| 1417415506 | Nicole Wagner | Social Worker | 280 Dobbs Ferry Rd Ste 303, White Plains, NY 10607-1900 | 2019-03-07 |
| 1265997605 | Nicole Jones Wagner | Physician Assistant | 1870 Pisgah Dr, Hendersonville, NC 28791-3759 | 2019-02-08 |
| 1881198059 | Nicole Wagner | Nurse Practitioner | 306 Race St, Holyoke, MA 01040-5720 | 2018-03-21 |
| 1942627484 | Nicole J Wagner | Nurse Practitioner | 975 Port Washington Rd, Grafton, WI 53024-9201 | 2014-03-22 |
| Street Address |
714 W MAIN ST |
| City | GRASS VALLEY |
| State | CA |
| Zip Code | 95945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821175258 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 714 W Main St, Grass Valley, CA 95945-6410 | 2006-11-01 |
| 1942808027 | Rachel Shearer | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-10-12 |
| 1578161659 | Melika Shafiee | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-10-12 |
| 1881292886 | Kai Woo | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-10-12 |
| 1609489970 | Mae Waldron | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-08-26 |
| 1720691090 | Micah Konyha | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-08-26 |
| 1699387290 | Elyssia Glassco | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-08-17 |
| 1790394773 | Blake Klein | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-07-27 |
| 1336758317 | Tony Tulloh | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-07-27 |
| 1487263463 | Zong Yang | Counselor | 714 W Main St, Grass Valley, CA 95945-6410 | 2020-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568028595 | Rae Meyer Bastoni | Chiropractor | 124 Clydesdale Ct, Ste. K, Grass Valley, CA 95945 | 2019-05-15 |
| 1255815221 | Victoria M Goddard | Counselor | 900 East Main St Suite 201, Grass Valley, CA 95945 | 2018-09-17 |
| 1912488503 | Janell Dawn Jones | Pharmacist | 10106 East Dr, Grass Valley, CA 95945 | 2018-08-22 |
| 1184114779 | Evan Ariel Walters | Physical Therapist | 104 Magaret Lane, Grass Valley, CA 95945 | 2018-05-18 |
| 1295199420 | Allyssa Fennelly Skowyra | Chiropractor | 155 Spring Hill Dr Ste 201, Grass Valley, CA 95945 | 2016-04-13 |
| 1326417627 | Nevada County Crisis Stabilization Unit | Clinic/Center | 145 Glasson Way, Grass Valley, CA 95945 | 2015-09-17 |
| 1942607957 | California Mental Health | Counselor | 120 N. Auburn Street, Ste 212, Grass Valley, CA 95945 | 2014-11-20 |
| 1740611615 | Jarrett M Weiss | Residential Treatment Facility, Emotionally Disturbed Children | 714 W. Main Street, Grass Valley, CA 95945 | 2013-12-03 |
| 1669802732 | Nicole Marie Sullivan | Residential Treatment Facility, Emotionally Disturbed Children | 714 W Main Street, Grass Valley, CA 95945 | 2013-11-26 |
| 1316377369 | Michelene Arielle-nicole Stringer | Residential Treatment Facility, Emotionally Disturbed Children | 714 West Main Street, Grass Valley, CA 95945 | 2013-11-12 |
| Find all providers in zip 95945 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740611615 | Jarrett M Weiss | Residential Treatment Facility, Emotionally Disturbed Children | 714 W. Main Street, Grass Valley, CA 95945 | 2013-12-03 |
| 1669802732 | Nicole Marie Sullivan | Residential Treatment Facility, Emotionally Disturbed Children | 714 W Main Street, Grass Valley, CA 95945 | 2013-11-26 |
| 1316377369 | Michelene Arielle-nicole Stringer | Residential Treatment Facility, Emotionally Disturbed Children | 714 West Main Street, Grass Valley, CA 95945 | 2013-11-12 |
| 1497907075 | Rick Edward Beberg | Residential Treatment Facility, Emotionally Disturbed Children | 714 West St., Grass Valley, CA 95945 | 2008-10-15 |
| 1932321221 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 13668 Auburn Rd, Grass Valley, CA 95949-8760 | 2007-05-03 |
| 1083836472 | Deborah Joy Gilcrest | Residential Treatment Facility, Emotionally Disturbed Children | 714 W. Main St., Grass Valley, CA 95945 | 2007-05-03 |
| 1891917365 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 17036 Bissell Place, Grass Valley, CA 95949 | 2007-05-03 |
| 1659593101 | Charis Youth Center | Residential Treatment Facility, Emotionally Disturbed Children | 12875 Rattlesnake Rd, Grass Valley, CA 95945 | 2007-05-03 |
| 1356562748 | Cristine Davis | Residential Treatment Facility, Emotionally Disturbed Children | 10171 Comerate Rd, Grass Valley, CA 95949-9058 | 2007-05-01 |
| 1104047588 | Jeanie Lyn Ibbotson | Residential Treatment Facility, Emotionally Disturbed Children | 11855 Slow Poke Ln, Grass Valley, CA 95945-8417 | 2007-05-01 |
| Find all providers in GRASS VALLEY | ||||
| City | GRASS VALLEY |
| Zip Code | 95945 |
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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.