Provider Demographics
NPI:1265663876
Name:WAGER, MARCUS JACKSON (RN)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:JACKSON
Last Name:WAGER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 S 500 W
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-9122
Mailing Address - Country:US
Mailing Address - Phone:765-374-3010
Mailing Address - Fax:
Practice Address - Street 1:161 S 500 W
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-9122
Practice Address - Country:US
Practice Address - Phone:765-374-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28078679A163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health