MRS. CAROLYN WAGNER


Address: 1770 E Lake Shore Dr, Suite 207, Decatur, IL 62521-3832
Phone: 2174299700

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).

Provider Overview

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

Taxonomy

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

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Office Location

Street Address 1770 E LAKE SHORE DR
SUITE 207
City DECATUR
State IL
Zip Code 62521-3832

Providers in the same location

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
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
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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
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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1922623610 Anastasiya A Drogoul Nurse Practitioner 2675 N Decatur Rd Ste 404, Decatur, GA 30033-6133 2020-06-09
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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
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Competitor

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City DECATUR
Zip Code 62521

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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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