Provider Demographics
NPI:1245403179
Name:WAGNER, MARSHA LYNN (RN,BSN)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LYNN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 TOWNSHIP ROAD 237
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645-8520
Mailing Address - Country:US
Mailing Address - Phone:740-533-2325
Mailing Address - Fax:
Practice Address - Street 1:870 TOWNSHIP ROAD 237
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645-8520
Practice Address - Country:US
Practice Address - Phone:740-533-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH205303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse