Provider Demographics
NPI:1760902001
Name:WAGNER, CATHERINE COLLINS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:COLLINS
Last Name:WAGNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:SHAY
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3578 FISHINGER BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7503
Mailing Address - Country:US
Mailing Address - Phone:614-457-4806
Mailing Address - Fax:
Practice Address - Street 1:55 TOWNSHIP ROAD 508 E
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7276
Practice Address - Country:US
Practice Address - Phone:740-377-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237455Medicaid