Individual
MS. ELLEN A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
265 HERRICK ROAD, SOUTHAMPTON, NY 11968
(631) 726-8350
(631) 726-8519
Mailing address
455 TOLL GATE RD, PRC AND CREDENTIALING, WARWICK, RI 02886
(401) 273-0641
(401) 273-2919
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
3472891
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN03496
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00164249
RR MEDICARE
—
Enumeration date
06/22/2006
Last updated
07/21/2023
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