ERIC DAVID WAGNER


Address: 405 W Jackson St, Carbondale, IL 62901-1462
Phone: 6185490721

ERIC DAVID WAGNER (NPI# 1306358445) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1306358445
Entity Type Individual
Full Name ERIC DAVID WAGNER
Practice Address 405 W Jackson St
Carbondale
IL 62901-1462
Mailing Address 11294 N County Line Rd
Carbondale
IL 62901-0784
Practice Telephone 6185490721
Mailing Telephone 7085606494
Enumeration Date 2017-10-30
Last Update Date 2017-10-30
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 367500000X Nurse Anesthetist, Certified Registered 209016825 IL Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
IL NBCRNA 118877 01

Other Providers ERIC WAGNER

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1619263241 Eric R Wagner Orthopaedic Surgery 59 Executive Park S Ste 2000, Atlanta, GA 30329-2208 2011-06-22
1326009143 Eric John Wagner Dentist 112 2nd Ave Nw, Hampton, IA 50441-1724 2006-03-31
1083222905 Eric Wagner Massage Therapist 2462 W 3rd St, Santa Rosa, CA 95401-6425 2020-07-16
1306312012 Eric Wagner Behavior Technician 2818 N Ralph Ave, Tucson, AZ 85712-1635 2018-10-19
1487043196 Eric Wagner Licensed Practical Nurse 526 W Main St, Sparta, WI 54656-2146 2015-01-19
1043563323 Eric Michael Wagner Pharmacist 110 Southside Blvd, Dillon, MT 59725-3536 2012-10-23
1528319365 Eric Bruce Wagner Pharmacist 330 Lebby St, Pelzer, SC 29669-1758 2012-09-19
1770856106 Eric Martin Wagner Physician Assistant Madigan Army Medical Center 9040 Jackson Ave, Tacoma, WA 98431-0001 2012-02-15
1477875078 Eric N Wagner Hearing Instrument Specialist 218 W Market St, Ste7, Charlottesville, VA 22902-5061 2010-02-23

Office Location

Street Address 405 W JACKSON ST
City CARBONDALE
State IL
Zip Code 62901-1462

Providers in the same location

NPI Name Taxonomy Address Enumeration
1194726851 Shahriar Bozorgzadeh Emergency Medicine 405 W Jackson St, Carbondale, IL 62901-1462 2005-08-03
1568071132 Cynthia Sue Davis Nurse Practitioner 405 W Jackson St, Carbondale, IL 62901-1462 2020-07-29
1629686019 Dianne Zuasula Catolos Physical Therapist 405 W Jackson St, Carbondale, IL 62901-1462 2020-07-21
1871113696 Summer R Black Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2020-04-22
1871123067 Hailee Elizabeth Bowlin Nurse Practitioner 405 W Jackson St, Carbondale, IL 62901-1462 2020-01-16
1972061737 Briana Nichole Jones Speech-Language Pathologist 405 W Jackson St, Carbondale, IL 62901-1462 2019-03-11
1700362183 John Grady Johnston Jr. Registered Nurse 405 W Jackson St, Carbondale, IL 62901 2018-07-18
1972099067 Andrew Mcnally Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2018-07-02
1134610587 Megan E Sims Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2018-05-22
1447749833 Erika Diericx Pharmacist 405 W Jackson St, Carbondale, IL 62901-1462 2018-05-01
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1558961268 Gerad Aaron Harsy Pharmacist Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 2020-10-30
1437708674 Board of Trustees of Southern Illinois University Clinic/Center 300 W Oak Street, Carbondale, IL 62901 2019-09-10
1306317383 Rachael O Johnson Nurse Practitioner 404 S. Lewis Ln, Carbondale, IL 62901 2018-12-17
1740795194 Megan Marie Zimmerman Nurse Practitioner 1100 W Diann Ln., Carbondale, IL 62901 2017-12-07
1295244242 Amy Elizabeth Prudencio Social Worker 1301 E. Walnut Street, Carbondale, IL 62901 2017-09-21
1740708171 Theresa Aleise Goodin Speech-Language Pathologist 1301 East Walnut Street, Carbondale, IL 62901 2017-09-06
1144762527 Kathleen Chwalisz Rigney Psychologist 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 2016-11-16
1285185173 Shawnee Health Service and Development Corp Social Worker 404 S. Lewis Lane, Carbondale, IL 62901 2016-10-17
1437605094 Arielle Greer Nurse's Aide 510 E. Russell St., A, Carbondale, IL 62901 2016-09-01
1518413863 Complete Family Eyecare of Carbondale, PC Optometrist 1241 East Walnut Street, Carbondale, IL 62901 2016-08-28
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Taxonomy Information

Taxonomy Code 367500000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Anesthetist, Certified Registered

Taxonomy Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1639223464 James David Wade Nurse Anesthetist, Certified Registered 35 Albany Rd Ste C, Carbondale, IL 62903-7605 2007-01-22
1811949910 Devon G Barnes Nurse Anesthetist, Certified Registered 35 Albany Road, Suite C, Carbondale, IL 62903 2006-05-17
1811989627 Pamela Kay Sparling Nurse Anesthetist, Certified Registered 450 W Jackson St, Dba Sih Medical Group Anesthesiology, Carbondale, IL 62901-1463 2005-08-17
1871113696 Summer R Black Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2020-04-22
1972099067 Andrew Mcnally Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2018-07-02
1134610587 Megan E Sims Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2018-05-22
1861991671 Ashley Marie Browning Nurse Anesthetist, Certified Registered 1239 E Main St, Carbondale, IL 62901-3175 2018-02-07
1205346483 Britley Ann White Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2017-10-02
1831608363 Phillip Dustin Deberry Nurse Anesthetist, Certified Registered 405 W Jackson St, Carbondale, IL 62901-1462 2017-09-27
1073031936 Nathaniel C Crum Nurse Anesthetist, Certified Registered 405 W Main St, Carbondale, IL 62901-2903 2017-08-31
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City CARBONDALE
Zip Code 62901

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Dataset Information

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.

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