Provider Demographics
NPI:1033469994
Name:WAGENER, CHRISTINA J (APN)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:J
Last Name:WAGENER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 135TH ST
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60418-1529
Mailing Address - Country:US
Mailing Address - Phone:708-358-7300
Mailing Address - Fax:
Practice Address - Street 1:5419 135TH ST
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-1529
Practice Address - Country:US
Practice Address - Phone:708-358-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000049363L00000X, 363LF0000X
OHAPRN.CNP.0040625363LF0000X
SCAPN.31164363LF0000X
IN71017358A363LF0000X
KY4048488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400228552OtherMEDICARE PTAN