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:
Health care specialties
| Specialty | Code | License # | 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 14 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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