NPIMap

Individual provider Active NPI

Courtney Danielle Wagaman

  • Student in an Organized Health Care Education/Training Program
  • Tumwater, WA
National Provider Identifier
1104553080
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1992 Ridgeview Loop SW Apt 206
Tumwater, WA 98512-1455
Phone
(360) 870-3332
NPI assigned
Aug 2, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X WA Primary

Addresses

Primary practice location

1992 Ridgeview Loop SW Apt 206
Tumwater, WA 98512-1455

Mailing address

1992 Ridgeview Loop SW Apt 206
Tumwater, WA 98512-1455
Phone (360) 870-3332

Other practice location 1

26812 118th Ave. E.
Graham, WA 98338
Phone (844) 623-9675

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

NPI Registry JSON

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

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1104553080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1992 RIDGEVIEW LOOP SW APT 206",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985121455",
            "telephone_number": "360-870-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1992 RIDGEVIEW LOOP SW APT 206",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985121455",
            "telephone_number": "360-870-3332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26812 118th Ave. E.",
            "address_purpose": "LOCATION",
            "city": "Graham",
            "state": "WA",
            "postal_code": "98338",
            "country_code": "US",
            "telephone_number": "844-623-9675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGAMAN",
        "first_name": "COURTNEY",
        "middle_name": "DANIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-08-02",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tumwater, WA

Sources for this page

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