Provider Demographics
NPI:1821753237
Name:WAGNER, SARA (CRNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 6TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2627
Mailing Address - Country:US
Mailing Address - Phone:717-849-2804
Mailing Address - Fax:717-850-4141
Practice Address - Street 1:1600 6TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2627
Practice Address - Country:US
Practice Address - Phone:717-849-2804
Practice Address - Fax:717-850-4141
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN623921163W00000X
PASP024743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse