Provider Demographics
NPI:1336250745
Name:WAGNER, ELENA BELL (PNP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:BELL
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 DURHAM RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6795
Mailing Address - Country:US
Mailing Address - Phone:207-869-4002
Mailing Address - Fax:207-869-4077
Practice Address - Street 1:23 DURHAM RD
Practice Address - Street 2:SUITE 303
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6795
Practice Address - Country:US
Practice Address - Phone:207-869-4002
Practice Address - Fax:207-869-4077
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MER039532363L00000X
NC0050-03139363LP0200X
MECNP141083363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner