Active NPI
Debra Smith Wagner, MSW
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1063446409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 14470
- Practice address
- Minneapolis Vamc-122
One Veterans Drive
Minneapolis, MN 55417 - Phone
- (612) 725-2042
- Fax
- (612) 725-2126
- NPI assigned
- Jul 10, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 14470 | MN | Primary |
Addresses
Primary practice location
Minneapolis Vamc-122
One Veterans Drive
Minneapolis, MN 55417
Mailing address
12918 Hamlet Ave
Apple Valley, MN 55124-9730
Phone (952) 454-3433
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14470 | MN | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063446409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12918 HAMLET AVE",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551249730",
"telephone_number": "952-454-3433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MINNEAPOLIS VAMC-122",
"address_2": "ONE VETERANS DRIVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55417",
"telephone_number": "612-725-2042",
"fax_number": "612-725-2126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DEBRA",
"middle_name": "SMITH",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "14470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.