Lacey Elizabeth Ruth Wagner, RN
Individual provider Active NPI School Registered Nurse · Davenport, NE
NPI 1275367294 · NPPES record last updated Aug 30, 2024
Key facts
- NPI
- 1275367294
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Registered Nurse 163WS0200X
- License
- 78245 (NE)
- Practice address
- 106 N Juniper Ave
Davenport, NE 68335-3010 - Phone
- (402) 364-2225
- NPI assigned
- Aug 30, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78245 | NE | MD | School Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bruning-Davenport Unified School District | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 78245 | NE | Yes |
Addresses
Primary practice location
106 N Juniper Ave
Davenport, NE 68335-3010
Mailing address
PO Box 273
Bruning, NE 68322-0273
Phone (402) 759-2742
Other providers in Davenport, NE
- Angela Kara Brase
- Bruning-Davenport Unified School District
- Nathan Scott Onnen
- Thayer County Memorial Hospital
All providers in Davenport, NE · School Registered Nurse in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.