Individual
DR. CHRISTINA J WAGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
5419 135TH ST, CRESTWOOD, IL 60418-1529
(708) 358-7300
Mailing address
5419 135TH ST, CRESTWOOD, IL 60418-1529
(708) 358-7300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277000049
IL
363LF0000X
Family Nurse Practitioner
277000049
IL
363LF0000X
Family Nurse Practitioner
4048488
KY
363LF0000X
Family Nurse Practitioner
71017358A
IN
363LF0000X
Family Nurse Practitioner
APN.31164
SC
363LF0000X
Family Nurse Practitioner
APRN.CNP.0040625
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400228552
MEDICARE PTAN
—
Enumeration date
09/18/2012
Last updated
12/13/2025
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