Provider Demographics
NPI:1811532864
Name:WAGNER, EMILYN WHITE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:EMILYN
Middle Name:WHITE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:EMILYN
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4109 WAKE FOREST RD STE 300
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-2508
Mailing Address - Country:US
Mailing Address - Phone:919-250-3478
Mailing Address - Fax:
Practice Address - Street 1:4109 WAKE FOREST RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2508
Practice Address - Country:US
Practice Address - Phone:919-250-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily