Individual
AMY R WAGGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN MSN FNP
Contact information
Practice address
1402 GRAND AVE, WASHINGTON, IN 47501-2122
(812) 257-0383
(812) 257-0433
Mailing address
PO BOX 760, WASHINGTON, IN 47501-0760
(812) 254-7310
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001500
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000390541
ANTHEM
IN
05
—
200461840
—
IN
01
—
CA5604
MEDICARE RAILROAD GROUP
IN
01
—
P00152106
MEDICARE RAILROAD
IN
Enumeration date
03/09/2006
Last updated
01/02/2021
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