Provider Demographics
NPI:1356416747
Name:WAGNER, DENISE CATHERINE (APRN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:CATHERINE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:20 YORK STREET OFFICE: DC 015D
Mailing Address - Street 2:YALE NEW HAVEN HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-688-5555
Mailing Address - Fax:203-688-3215
Practice Address - Street 1:YALE-NEW HAVEN HOSPITAL , 20 YORK STREET
Practice Address - Street 2:PRIMARY CARE CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-688-9335
Practice Address - Fax:203-688-6514
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-08-12
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Provider Licenses
StateLicense IDTaxonomies
CT0000711363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004185139Medicaid