Provider Demographics
NPI:1962597765
Name:WAGNER, KAREN M (RN MSN CPNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RN MSN CPNP
Other - Prefix:
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Mailing Address - Street 1:5024 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9230
Mailing Address - Country:US
Mailing Address - Phone:231-935-0555
Mailing Address - Fax:231-935-0562
Practice Address - Street 1:5024 N ROYAL DRIVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-0555
Practice Address - Fax:231-935-0562
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704166418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner