Brooke Marie Wagner, BSN-RN, PHN

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

2480220 Issued in MN

Practice address

Altru Clinic Crookston
400 S Minnesota Street
Crookston, MN 56716

Phone

(218) 281-9100

NPI assigned

Sep 15, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1694736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1134907710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 GOLF TER",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161107",
            "telephone_number": "218-289-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ALTRU CLINIC CROOKSTON",
            "address_2": "400 S MINNESOTA STREET",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "56716",
            "telephone_number": "218-281-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BROOKE",
        "middle_name": "MARIE",
        "credential": "BSN-RN, PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "MN",
            "license": "2480220",
            "primary": true
        },
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "ND",
            "license": "R48895",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheri Lynn Vanderzwaag, MA, LPCC
• Myron Joseph Veenstra, PH.D
• Brett K Vibeto, MD
• Villa St. Vincent
• Shirley Anne Waechter
• Valerie Wagner, LADC, LPCC
• Heather Lynn Waldal, FNP-C
• Gavin Lee Walker
• Walmart Inc.
• Casey Wangen

• Community Health Registered Nurse in Crookston, MN
• Providers in Crookston, MN by specialty
• Community Health Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.