Provider Demographics
NPI:1134523269
Name:WAGNER, CASSIE J (NP)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:J
Last Name:WAGNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:J
Other - Last Name:BROOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:403 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:BELMOND
Mailing Address - State:IA
Mailing Address - Zip Code:50421-1201
Mailing Address - Country:US
Mailing Address - Phone:641-444-3500
Mailing Address - Fax:515-532-9245
Practice Address - Street 1:840 W US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1023
Practice Address - Country:US
Practice Address - Phone:641-925-1500
Practice Address - Fax:641-925-1507
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC112229363LA2100X, 363LP0200X, 363LP0222X
IAC156954363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care