Provider Demographics
NPI:1912795311
Name:WAGNER, PAMELA JANE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:WAGNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87658 527 AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETOON
Mailing Address - State:NE
Mailing Address - Zip Code:68789-8022
Mailing Address - Country:US
Mailing Address - Phone:402-360-0972
Mailing Address - Fax:
Practice Address - Street 1:87658 527 AVE
Practice Address - Street 2:
Practice Address - City:WINNETOON
Practice Address - State:NE
Practice Address - Zip Code:68789-8022
Practice Address - Country:US
Practice Address - Phone:402-358-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide