CHRISTOPHER JOSEPH WAGNER (NPI# 1861029779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861029779 |
| Entity Type | Individual |
| Full Name | CHRISTOPHER JOSEPH WAGNER |
| Credential | DO |
| Practice Address |
530 Ne Glen Oak Ave Peoria IL 61637-0001 |
| Mailing Address |
1964 N Blue Water Ct Suttons Bay MI 49682-9745 |
| Practice Telephone | 3096557768 |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-04-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174124671 | Christopher Wagner | Pharmacist | 795 Texas Ave, Bridge City, TX 77611-4227 | 2020-11-03 |
| 1932738424 | Christopher Raymond Wagner | Student in an Organized Health Care Education/Training Program | 999 N 92nd St, Milwaukee, WI 53226-4875 | 2020-04-06 |
| 1386104347 | Christopher Michael Wagner | Internal Medicine | 1775 Ballard Rd, Park Ridge, IL 60068-1005 | 2019-03-24 |
| 1548786353 | Christopher Wagner | Registered Nurse | 424 Savannah Rd, Lewes, DE 19958-1462 | 2017-08-15 |
| 1982134482 | Christopher Charles Wagner | Family Medicine | 71 Bevier St, Shelby, MI 49455-1209 | 2017-06-16 |
| 1023562907 | Christopher Wagner | Dentist | 4700 42nd Ave Sw, Suite 460, Seattle, WA 98116-4591 | 2016-08-09 |
| 1578920559 | Christopher Michael Wagner | Counselor | 793 Old Route 119 Hwy N, Indiana, PA 15701-1372 | 2016-01-22 |
| 1235546789 | Christopher Wagner | Physical Therapist | 2433 Country Place Blvd, Bldg B, Trinity, FL 34655-1163 | 2014-07-16 |
| 1861786063 | Christopher Phillip Wagner | Radiology | 6600 Van Aalst Blvd, Martin Army Community Hospital, Fort Benning, GA 31905-0000 | 2011-06-06 |
| 1780908731 | Christopher J Wagner | Physical Therapist | 52 Rising Sun Town Ctr, Rising Sun, MD 21911-1902 | 2010-03-19 |
| Street Address |
530 NE GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346235777 | Jack Michael Gibson | Obstetrics & Gynecology | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2005-09-12 |
| 1053912188 | Janie Clary | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-11-04 |
| 1265030548 | Christina David | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-10-09 |
| 1033726831 | Corry Lynn Rediger | Occupational Therapist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-25 |
| 1720694094 | Katelynn M Madden | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-09-21 |
| 1568074474 | Amanda Diane Beoletto | Pharmacist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-08-21 |
| 1881212892 | Mohammad Mousbah Al-tabbaa | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1750909693 | Mohammad Gareeb | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-07-07 |
| 1376160846 | Bassel Elia Abouzeid | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave, Peoria, IL 61637 | 2020-07-01 |
| 1700403516 | Christina Marie Spurgeon | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821609751 | Amanda Ferreira | Student in an Organized Health Care Education/Training Program | 7421 W Shangri La Rd, Peoria, AZ 85345-5811 | 2020-08-13 |
| 1699396838 | Ashif Khaled Molla | Student in an Organized Health Care Education/Training Program | Osf St Francis Medical Center 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-04-28 |
| 1437779063 | Mena Henien | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave Bldg 5676, Peoria, IL 61637-0001 | 2020-04-23 |
| 1306465893 | Sarath Kumar Jaganathan Jaishankar | Student in an Organized Health Care Education/Training Program | 530 Ne Glenn Oak Avenue, Peoria, IL 61637-0001 | 2020-04-14 |
| 1952920522 | Phu Si Huynh | Student in an Organized Health Care Education/Training Program | 331 Fulton St Apt 302, Peoria, IL 61602-1436 | 2020-04-13 |
| 1730736604 | Gabriela C Isenia | Student in an Organized Health Care Education/Training Program | 9031 W Tonopah Dr, Peoria, AZ 85382-6445 | 2019-08-24 |
| 1831751643 | Noreen Khan | Student in an Organized Health Care Education/Training Program | 1501 W Coneflower Dr Apt 2212, Peoria, IL 61615-7465 | 2019-07-01 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| Find all providers in PEORIA | ||||
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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.