Individual
AMANDA K. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN.CNP
Contact information
Practice address
2050 KENNY RD, COLUMBUS, OH 43221-3502
(614) 293-6529
(614) 293-9469
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 293-6529
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN.CNP.11911
OH
363LA2200X
Adult Health Nurse Practitioner
Primary
COA.11911-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3128636
—
OH
Enumeration date
09/21/2010
Last updated
12/14/2020
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