Active NPI
Britt Elisia Wagner, L.L.P.
- Psychologist
- Flint, MI
National Provider Identifier
1275680779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301009571
- Practice address
- 725 Mason St
Flint, MI 48503-2421 - Phone
- (810) 257-1325
- NPI assigned
- Jan 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301009571 | MI | Primary |
Addresses
Primary practice location
725 Mason St
Flint, MI 48503-2421
Mailing address
115 N Adelaide St
Fenton, MI 48430-2614
Phone (810) 750-2720
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301009571 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275680779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 N ADELAIDE ST",
"city": "FENTON",
"state": "MI",
"postal_code": "484302614",
"telephone_number": "810-750-2720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 MASON ST",
"city": "FLINT",
"state": "MI",
"postal_code": "485032421",
"telephone_number": "810-257-1325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "BRITT",
"middle_name": "ELISIA",
"credential": "L.L.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301009571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.