Kimberlee Wagner, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN 271004 Issued in CA

Practice address

16360 Roscoe Blvd
2ND Floor
Van Nuys, CA 91406-1219

Phone

(818) 901-4830

NPI assigned

Jun 2, 2016

Last updated

Jun 2, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1093163784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18115 ANDREA CIR N",
            "address_2": "UNIT 1",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251161",
            "telephone_number": "818-321-7985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16360 ROSCOE BLVD",
            "address_2": "2ND FLOOR",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914061219",
            "telephone_number": "818-901-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KIMBERLEE",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN 271004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haindavi Vutukuri
• William Wacker
• Curtis Wade
• Keyoka L Wade
• Krystal Monique Wade
• Ryen Wagner
• Trudy Wagner, MFT
• Wahba Dental Corp (Sherman Way Dental Group)
• Maged Fares Wahba, DDS
• Natalie Wainer

• Licensed Vocational Nurse in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.