Provider Demographics
NPI:1346433174
Name:WAGNER, MARSHA (RN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2315
Mailing Address - Country:US
Mailing Address - Phone:805-237-3050
Mailing Address - Fax:805-237-3057
Practice Address - Street 1:723 WALNUT DR
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2315
Practice Address - Country:US
Practice Address - Phone:805-237-3050
Practice Address - Fax:805-237-3057
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD234238163WC0400X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No251K00000XAgenciesPublic Health or Welfare