Provider Demographics
NPI:1699862318
Name:WAGNER, DEBRA E (ARNP, CCRN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:E
Last Name:WAGNER
Suffix:
Gender:F
Credentials:ARNP, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N SAINT FRANCIS ST STE 130
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2865
Mailing Address - Country:US
Mailing Address - Phone:316-264-3505
Mailing Address - Fax:316-264-0908
Practice Address - Street 1:1100 N SAINT FRANCIS ST STE 130
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2865
Practice Address - Country:US
Practice Address - Phone:316-264-3505
Practice Address - Fax:316-264-0908
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44988363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100365670BMedicaid
KSP13479Medicare UPIN
KS161770Medicare ID - Type Unspecified