Active NPI
Mary Wagenhoffer, APRN
- Nurse Practitioner
- Eatontown, NJ
National Provider Identifier
1326170754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 26NC07020000
- Practice address
- 615 Hope Rd, BLDG 5
Eatontown, NJ 07724 - Phone
- (732) 571-1000
- Fax
- (732) 571-1156
- NPI assigned
- Mar 12, 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 26NC07020000 | NJ | Primary |
Addresses
Primary practice location
615 Hope Rd, BLDG 5
Eatontown, NJ 07724
Mailing address
615 Hope Rd, BLDG 5
Eatontown, NJ 07724
Phone (732) 571-1000
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NC07020000 | NJ | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326170754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 HOPE RD, BLDG 5",
"city": "EATONTOWN",
"state": "NJ",
"postal_code": "07724",
"telephone_number": "732-571-1000",
"fax_number": "732-571-1156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 HOPE RD, BLDG 5",
"city": "EATONTOWN",
"state": "NJ",
"postal_code": "07724",
"telephone_number": "732-571-1000",
"fax_number": "732-571-1156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGENHOFFER",
"first_name": "MARY",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NJ",
"license": "26NC07020000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eatontown, NJ
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.