Provider Demographics
NPI:1093385148
Name:WAGNER-CONNOLLY, AMBERLY CATHERINE (DNP, MSN, RN)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:CATHERINE
Last Name:WAGNER-CONNOLLY
Suffix:
Gender:F
Credentials:DNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 SOUTH 216TH STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028
Mailing Address - Country:US
Mailing Address - Phone:402-659-3855
Mailing Address - Fax:
Practice Address - Street 1:11815 SOUTH 216TH STREET
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028
Practice Address - Country:US
Practice Address - Phone:402-659-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62147163W00000X
NE114610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse