Individual
MONA H WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-8610
Mailing address
PO BOX 714960, COLUMBUS, OH 43271-4960
(205) 322-1808
(205) 322-1851
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
25214
WV
367500000X
Certified Registered Nurse Anesthetist
9418194
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9418194
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721837
BCBS
WV
01
—
01706470
MSBCBS GROUP
WV
05
—
0207026000
—
WV
05
—
0573001000
—
WV
01
—
1045609
W/COMP
WV
05
—
117174600
—
FL
05
—
2107900
—
OH
01
—
23492135300
W/COMP
OH
01
—
270052997002
TRICARE
WV
05
—
74008822
—
KY
01
—
DA0096
RR MEDICARE
WV
01
—
DF0767
RR MEDICARE
WV
01
—
P00001160
RR MEDICARE
WV
01
—
P00241517
RR MEDICARE
WV
Enumeration date
11/27/2006
Last updated
04/06/2023
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