Provider Demographics
NPI:1316369408
Name:WAGNER, FUHRMA RACHAEL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:FUHRMA
Middle Name:RACHAEL
Last Name:WAGNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:FUHRMA
Other - Middle Name:RACHAEL
Other - Last Name:ALAVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:664 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:BRUNDIDGE
Mailing Address - State:AL
Mailing Address - Zip Code:36010-1202
Mailing Address - Country:US
Mailing Address - Phone:334-536-1001
Mailing Address - Fax:334-536-1006
Practice Address - Street 1:664 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BRUNDIDGE
Practice Address - State:AL
Practice Address - Zip Code:36010-1202
Practice Address - Country:US
Practice Address - Phone:334-536-1001
Practice Address - Fax:334-536-1006
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-120299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily