Provider Demographics
NPI:1255354551
Name:WEGNER, AMY L (RNC, MSN, WHNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:WEGNER
Suffix:
Gender:F
Credentials:RNC, MSN, WHNP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC, MSN, WHNP
Mailing Address - Street 1:20375 W 151ST ST STE 409
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7210
Mailing Address - Country:US
Mailing Address - Phone:913-829-5656
Mailing Address - Fax:913-829-1513
Practice Address - Street 1:20375 W 151ST ST STE 409
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7210
Practice Address - Country:US
Practice Address - Phone:913-829-5656
Practice Address - Fax:913-829-1513
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ38456Medicare UPIN