Individual
MRS. REBECCA ANNE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN RN PMHNP BC
Contact information
Practice address
4040 MEMORIAL PKWY SW, HUNTSVILLE, AL 35802-4364
(256) 705-6444
Mailing address
4040 MEMORIAL PKWY SW, HUNTSVILLE, AL 35802-4364
(256) 533-1970
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-180194
AL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2025063408
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330000014
—
AL
Enumeration date
02/23/2024
Last updated
12/22/2025
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