Provider Demographics
NPI:1881182921
Name:WAGNER, MONICA (CD(DONA))
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10156 STATE HIGHWAY 172
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-9126
Mailing Address - Country:US
Mailing Address - Phone:970-903-4401
Mailing Address - Fax:
Practice Address - Street 1:10156 STATE HIGHWAY 172
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137-9126
Practice Address - Country:US
Practice Address - Phone:970-903-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula