Active NPI
Debra Lynne Waggle, APN
- Family Nurse Practitioner
- Olney, IL
National Provider Identifier
1316984594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 71001718A
- Practice address
- 1200 N East St
Olney, IL 62450-2432 - Phone
- (618) 395-6243
- NPI assigned
- May 31, 2006
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 71001718A | IN | Primary |
Addresses
Primary practice location
1200 N East St
Olney, IL 62450-2432
Mailing address
800 E Locust St
Olney, IL 62450-2553
Phone (618) 395-7340
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71001718A | IN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453075200000",
"number": "1316984594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 E LOCUST ST",
"city": "OLNEY",
"state": "IL",
"postal_code": "624502553",
"telephone_number": "618-395-7340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N EAST ST",
"city": "OLNEY",
"state": "IL",
"postal_code": "624502432",
"telephone_number": "618-395-6243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGLE",
"first_name": "DEBRA",
"middle_name": "LYNNE",
"name_prefix": "Ms.",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-31",
"last_updated": "2016-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IN",
"license": "71001718A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olney, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.