MATTHEW WAGNER NPI 1053785840

NPI Information

NPI: 1053785840
Provider Name: MATTHEW WAGNER
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1200 GRANT BLVD W
WABASHA, MN
ZIP 55981
Phone: (651) 565-5600
Get Directions

Matthew Wagner is a family nurse practitioner in Wabasha, MN with 9 years of experience. Matthew Wagner NPI is 1053785840. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2015

The provider's business location address is:

1200 GRANT BLVD W
WABASHA, MN
ZIP 55981
Phone: (651) 565-5600

The NPI 1053785840 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/17/2015 and was last updated on 11/14/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	CNP 4307	MINNESOTA	Yes
2	163W00000X	Registered Nurse		R 170201-9	MINNESOTA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CNP 4307	OTHER	MINNESOTA	APRN LICENSE
2	R 170201-9	OTHER	MINNESOTA	RN LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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