Provider Demographics
NPI:1346281870
Name:WAGNER, FAITH M (FNP-C)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:M
Other - Last Name:ERICKSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4441
Practice Address - Country:US
Practice Address - Phone:701-323-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR24068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP00655489OtherRR MEDICARE
ND1452844Medicaid
ND1452844Medicaid
NDN713729Medicare PIN