Ernestine Wagner, PA, Inc

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110001577 Issued in VA

Legal business name

ERNESTINE WAGNER, PA, INC

Practice address

29306 G C Peery Highway
North Tazewell, VA 24630-9192

Phone

(276) 979-1309

Fax

(188) 851-0261

NPI assigned

Dec 23, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Ernestine WagnerNPI 1124072889

Title

Owner

Phone

(276) 979-1309

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ernestine A Wagner, PA

  • Medical Physician Assistant
  • Stevens Point, WI
  • NPI 1124072889
  NPD (past) Authorized official

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

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229990400000",
    "number": "1184860074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29306 G C PEERY HIGHWAY",
            "city": "NORTH TAZEWELL",
            "state": "VA",
            "postal_code": "246309192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29306 G C PEERY HIGHWAY",
            "city": "NORTH TAZEWELL",
            "state": "VA",
            "postal_code": "246309192",
            "telephone_number": "276-979-1309",
            "fax_number": "188-851-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERNESTINE WAGNER, PA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-23",
        "last_updated": "2008-12-23",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ERNESTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "276-979-1309",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in North Tazewell, VA
• Providers in North Tazewell, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2008; 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.