Michelle Diane Waggoner, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN.130695.MEDS-IV Issued in OH

Practice address

8120 Garnet Dr
Dayton, OH 45458-2141

Phone

(513) 834-7063

Fax

(513) 873-1567

NPI assigned

Feb 21, 2019

Sex

Female

Sole proprietor

No

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": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1124585641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 MORGAN ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452062348",
            "telephone_number": "513-834-7063",
            "fax_number": "513-873-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 GARNET DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454582141",
            "telephone_number": "513-834-7063",
            "fax_number": "513-873-1567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "MICHELLE",
        "middle_name": "DIANE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-21",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "LPN.130695.MEDS-IV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonya Wadekamper
• Michael Wadham, MSW, LSW
• Shernaz Aspi Wadia, MD
• Porcha D Wafford, LSW
• Heather Lynne Waggoner, LISWS
• Amanda Wagner
• Ashley Wagner
• Cole Wagner, QMHS
• Jami Wagner
• Julie Wagner, R.D.

• Licensed Practical Nurse in Dayton, OH
• Providers in Dayton, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; 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.