Provider Demographics
NPI:1316618291
Name:WAGNER, CRYSTAL DAWN (FNP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:DAWN
Other - Last Name:SESSION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:411 DARRELL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4544
Mailing Address - Country:US
Mailing Address - Phone:740-645-9114
Mailing Address - Fax:
Practice Address - Street 1:1181 FREEDOM RD
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-4913
Practice Address - Country:US
Practice Address - Phone:724-742-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily