Provider Demographics
NPI:1376422725
Name:WAGNER, HEATHER A (CNS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:WAGNER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N49W7951 WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9023
Mailing Address - Country:US
Mailing Address - Phone:414-232-2301
Mailing Address - Fax:
Practice Address - Street 1:N49W7951 WESTERN RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9023
Practice Address - Country:US
Practice Address - Phone:414-232-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177617-30364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist