Provider Demographics
NPI:1114648771
Name:WAGERS, ELEANOR LYNETTE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:LYNETTE
Last Name:WAGERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:TN
Mailing Address - Zip Code:37616-6057
Mailing Address - Country:US
Mailing Address - Phone:423-278-0367
Mailing Address - Fax:
Practice Address - Street 1:801 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-6219
Practice Address - Country:US
Practice Address - Phone:423-588-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily