Provider Demographics
NPI:1407837909
Name:WEGNER, NICOLE DENISE (CRNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:WEGNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DENISE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1733 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6638
Mailing Address - Country:US
Mailing Address - Phone:301-797-2525
Mailing Address - Fax:301-797-5519
Practice Address - Street 1:1733 HOWELL RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6638
Practice Address - Country:US
Practice Address - Phone:301-797-2525
Practice Address - Fax:301-797-5519
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122406363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care