Individual
STEPHANIE ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3699 EPWORTH RD, NEWBURGH, IN 47630-8909
(812) 471-1200
(812) 475-6700
Mailing address
PO BOX 44994, INDIANAPOLIS, IN 46244-0994
(317) 274-4402
(317) 278-1302
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
01065554A
IN
207RH0003X
Hematology & Oncology Physician
38720
KY
207RX0202X
Medical Oncology Physician
Primary
01065554A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000991170
ANTHEM PIN
IN
05
—
200911200
—
IN
01
—
50020098
PASSPORT
KY
05
—
7100058720
—
KY
Enumeration date
01/31/2007
Last updated
02/24/2025
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