Provider Demographics
NPI:1326145129
Name:WAGEMAN, JULIA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:WAGEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N 102ND CT STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2194
Mailing Address - Country:US
Mailing Address - Phone:402-502-2747
Mailing Address - Fax:402-502-2387
Practice Address - Street 1:1111 N 102ND CT STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-502-2747
Practice Address - Fax:402-502-2387
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE40320163W00000X, 163WN0300X, 174400000X
NE110314363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0993865Medicaid
NE098501Medicare PIN
NES75018Medicare UPIN
IA0993865Medicaid
IA500005775Medicare PIN
NENA1910Medicare PIN