Anthony Vanwagner, MA.OM. L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

1609 Issued in MN

Practice address

14464 Sumter Ave
Savage, MN 55378-1727

Phone

(651) 367-9929

NPI assigned

Jan 29, 2017

Last updated

Feb 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mr. Anthony Burton Vanwagner Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645920000000",
    "number": "1053858092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14464 SUMTER AVE",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "553781727",
            "telephone_number": "651-367-9929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14464 SUMTER AVE",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "553781727",
            "telephone_number": "651-367-9929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANWAGNER",
        "first_name": "ANTHONY",
        "credential": "MA.OM. L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-29",
        "last_updated": "2022-02-27",
        "certification_date": "2022-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "WI",
            "license": "767-55",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MN",
            "license": "1609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANTHONY",
            "last_name": "VANWAGNER",
            "middle_name": "BURTON",
            "prefix": "MR.",
            "credential": "MA.OM. L.AC.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Acupuncturist in Savage, MN
• Providers in Savage, MN by specialty
• Acupuncturist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.