Provider Demographics
NPI:1013130913
Name:WAGNER, NATALIE A (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:A
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:SARISCANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8901 INDIAN HILLS DR STE 350B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4038
Mailing Address - Country:US
Mailing Address - Phone:402-991-9630
Mailing Address - Fax:402-502-0795
Practice Address - Street 1:7101 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2164
Practice Address - Country:US
Practice Address - Phone:402-572-2916
Practice Address - Fax:402-572-3258
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7909101YM0800X
NE482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083066228Medicaid