Provider Demographics
NPI:1649276841
Name:KRAUSE-WAGNER, ERICA J (APNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:KRAUSE-WAGNER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:50 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IA
Practice Address - Zip Code:52151-7729
Practice Address - Country:US
Practice Address - Phone:563-538-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2191363LF0000X
IA109657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43988700Medicaid
WI0057Medicare PIN
P83566Medicare UPIN