Provider Demographics
NPI:1831925072
Name:WAGNER, DENISE LEA (CNM)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LEA
Last Name:WAGNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 MERLE HAY RD UNIT 213
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1596
Mailing Address - Country:US
Mailing Address - Phone:515-452-6218
Mailing Address - Fax:
Practice Address - Street 1:1264 RIBAUT RD STE 200
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6127
Practice Address - Country:US
Practice Address - Phone:843-524-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB180151367A00000X
SC29673367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife