Provider Demographics
NPI:1811706245
Name:WAGNITZ, ASHLEY LEE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LEE
Last Name:WAGNITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LEE
Other - Last Name:SCHELLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:GIBBON
Mailing Address - State:NE
Mailing Address - Zip Code:68840-0218
Mailing Address - Country:US
Mailing Address - Phone:308-233-7687
Mailing Address - Fax:
Practice Address - Street 1:101 GILMORE ST
Practice Address - Street 2:
Practice Address - City:GIBBON
Practice Address - State:NE
Practice Address - Zip Code:68840-6242
Practice Address - Country:US
Practice Address - Phone:308-233-7684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant