Provider Demographics
NPI:1700553781
Name:WAGLER, SHAYNA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:WAGLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-0556
Mailing Address - Country:US
Mailing Address - Phone:812-494-9501
Mailing Address - Fax:812-494-9502
Practice Address - Street 1:2007 STATE ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8505
Practice Address - Country:US
Practice Address - Phone:812-254-1558
Practice Address - Fax:812-254-8308
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011487A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health