Provider Demographics
NPI:1558638593
Name:WAGENSELLER, WARD FREDERICK (RN, EMT-P)
Entity Type:Individual
Prefix:MR
First Name:WARD
Middle Name:FREDERICK
Last Name:WAGENSELLER
Suffix:
Gender:M
Credentials:RN, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13919 CALVARY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3411
Mailing Address - Country:US
Mailing Address - Phone:858-243-2027
Mailing Address - Fax:
Practice Address - Street 1:13919 CALVARY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3411
Practice Address - Country:US
Practice Address - Phone:858-243-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse