MRS. CAROLYN WAGNER (NPI# 1366419087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1366419087 |
Entity Type | Individual |
Full Name | MRS. CAROLYN WAGNER |
Credential | NP |
Practice Address |
1770 E Lake Shore Dr Suite 207 Decatur IL 62521-3832 |
Practice Telephone | 2174299700 |
Practice Fax Number | 2174299702 |
Mailing Telephone | 2174299700 |
Mailing Fax Number | 2174299702 |
Enumeration Date | 2006-03-01 |
Last Update Date | 2011-03-10 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209-001389 | IL | Physician Assistants & Advanced Practice Nursing Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821092529 | Carolyn A. Wagner | Registered Nurse | 300 Westminster Canterbury Dr, Winchester, VA 22603-4216 | 2005-06-09 |
1467986141 | Carolyn Wagner | Counselor | 1159 Wilmette Ave, Suite 225, Wilmette, IL 60091-2649 | 2017-04-19 |
1508210931 | Carolyn Blair Wagner | Pediatrics | 1065 Southern Blvd, Department of Pediatrics, Bronx, NY 10459-2417 | 2016-04-22 |
1801142302 | Carolyn Wagner | Student in an Organized Health Care Education/Training Program | 6431 Fannin St, Msb 3.020b, Houston, TX 77030-1501 | 2012-08-02 |
1679705941 | Carolyn M Wagner | Physician Assistant | 1425 Portland Ave, Rochester, NY 14621-3001 | 2009-08-19 |
1306002506 | Carolyn Wagner | Physical Therapy Assistant | 1130 N Westfield St, Oshkosh, WI 54902-3217 | 2008-08-06 |
Street Address |
1770 E LAKE SHORE DR SUITE 207 |
City | DECATUR |
State | IL |
Zip Code | 62521-3832 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942292412 | David Anthony Jones | Family Medicine | 1770 E Lake Shore Dr, Suite 305, Decatur, IL 62521-3832 | 2005-08-19 |
1306314778 | Kristy Dawn Shafer | Nurse Practitioner | 1770 E Lake Shore Dr, Decatur, IL 62521-3832 | 2018-11-05 |
1902340730 | Annie Michele Smith | Social Worker | 1770 E Lake Shore Dr, #209, Decatur, IL 62521-3832 | 2016-12-13 |
1013319623 | Nicole Marie Lord | Nurse Practitioner | 1770 E Lake Shore Dr, #309, Decatur, IL 62521-3832 | 2014-09-25 |
1508110198 | Leslie Stanislaus Anewenah | Surgery | 1770 E Lake Shore Dr, Decatur, IL 62521-3832 | 2012-11-04 |
1063797108 | Laurel A Walton Do Sc | Obstetrics & Gynecology | 1770 E Lake Shore Dr, Ste 309, Decatur, IL 62521-3832 | 2011-10-20 |
1447532924 | Ahmad H Ahmad Md Sc | Internal Medicine | 1770 E Lake Shore Dr, Ste 201, Decatur, IL 62521-3832 | 2011-09-12 |
1912233602 | Linda Wilson Klemm | Nurse Practitioner | 1770 E Lake Shore Dr, Suite 105, Decatur, IL 62521-3832 | 2009-10-30 |
1265675490 | Jennifer Ross-barnett | Nurse Practitioner | 1770 E Lake Shore Dr, Suite 207, Decatur, IL 62521-3831 | 2009-04-17 |
1447403936 | Choudary V. Kavuri Md, Sc | Psychiatry & Neurology | 1770 E Lake Shore Dr, Suite 208, Decatur, IL 62521-3832 | 2008-10-28 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
Find all providers in zip 62521 |
Taxonomy Code | 363LF0000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Family |
Definition to come... |
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1134729965 | Jamie Mclemore | Nurse Practitioner | 17619 Hwy 58 North, Decatur, TN 37322-3732 | 2020-10-30 |
1790383776 | Angela Tope Adeleke | Nurse Practitioner | 3185 Georgian Woods Cir, Decatur, GA 30034-5105 | 2020-10-13 |
1417564147 | Jigna Patel | Nurse Practitioner | 1963 Don Juan Ln, Decatur, GA 30032-4218 | 2020-09-27 |
1659983856 | Emilie Carsell Mathias | Nurse Practitioner | 2208 N Crossing Way, Decatur, GA 30033-4175 | 2020-08-19 |
1275151078 | Tiffanie Marshall Mcguire | Nurse Practitioner | 2042 Beltline Rd Sw Ste B101, Decatur, AL 35601-5571 | 2020-07-08 |
1922623610 | Anastasiya A Drogoul | Nurse Practitioner | 2675 N Decatur Rd Ste 404, Decatur, GA 30033-6133 | 2020-06-09 |
1174156244 | Anne Marie Strickland | Nurse Practitioner | 3109 Vicksburg Pl Sw, Decatur, AL 35603-3107 | 2020-02-18 |
1174161822 | Allison Leanne Hall | Nurse Practitioner | 304 W Hay St Ste 312, Decatur, IL 62526-4170 | 2019-12-12 |
1396387866 | Elizabeth Nichole Mathews | Nurse Practitioner | 2301 S Fm 51 Ste 100, Decatur, TX 76234-3864 | 2019-10-16 |
1861040479 | Oladunni Funmi Faminu | Nurse Practitioner | 2701 N Decatur Rd # 2400, Decatur, GA 30033-5918 | 2019-08-27 |
Find all providers in DECATUR |
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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.