Provider Demographics
NPI:1639892136
Name:WAGERS, MARTI (NP)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:WAGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306417
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6417
Mailing Address - Country:US
Mailing Address - Phone:931-253-1110
Mailing Address - Fax:931-722-9919
Practice Address - Street 1:980 N MERIDIAN STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1129
Practice Address - Country:US
Practice Address - Phone:260-703-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013022A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily