Wagner, Carolyn

Wagner, Carolyn is an individual health care provider with primary practice located at 1770 E Lake Shore Dr Suite 207, Decatur IL 62521-3832. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wagner, Carolyn can be contacted via phone (217) 429-9700.

Contact Information

Primary practice address
1770 E Lake Shore Dr Suite 207 Decatur IL 62521-3832
Phone: (217) 429-9700
Fax: (217) 429-9702
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209-001389 Illinois

Profile Details

NPI number 1366419087
LBN Legal business name Wagner, Carolyn
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2006
Last updated Mar 10th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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