Provider Demographics
NPI:1477596468
Name:WAGNER, ELIZABETH MARIE (RN, MSN, CPNP-AC)
Entity Type:Individual
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First Name:ELIZABETH
Middle Name:MARIE
Last Name:WAGNER
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Gender:F
Credentials:RN, MSN, CPNP-AC
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Mailing Address - Street 1:1019 DANUBE AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4636
Mailing Address - Country:US
Mailing Address - Phone:612-813-7336
Mailing Address - Fax:612-813-7336
Practice Address - Street 1:2525 CHICAGO AVE # MS 324203
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:126-813-7336
Practice Address - Fax:612-813-7660
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-13
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Provider Licenses
StateLicense IDTaxonomies
IL41272234363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care