Elena Bell Wagner, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

CNP141083 Issued in ME

Practice address

23 Durham Rd
Suite 303
Freeport, ME 04032-6795

Phone

(207) 869-4002

Fax

(207) 869-4077

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mercy Hospital

  • General Acute Care Hospital
  • Portland, ME
  • NPI 1629078712
  Medicare reassignment NPD
• Mercy Hospital

  • Rural Health Clinic/Center
  • Windham, ME
  • NPI 1396496378
  NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463097600000",
    "number": "1336250745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 DURHAM RD",
            "address_2": "SUITE 303",
            "city": "FREEPORT",
            "state": "ME",
            "postal_code": "040326795",
            "telephone_number": "207-869-4002",
            "fax_number": "207-869-4077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 DURHAM RD",
            "address_2": "SUITE 303",
            "city": "FREEPORT",
            "state": "ME",
            "postal_code": "040326795",
            "telephone_number": "207-869-4002",
            "fax_number": "207-869-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELENA",
        "middle_name": "BELL",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ME",
            "license": "R039532",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "0050-03139",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ME",
            "license": "CNP141083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Elisabeth Tierce-Hazard, AGPCNP-BC, PHMNP-BC
• Kazutoshi Toita, P.T.
• Town of Freeport
• Beverly M Towne, MD
• Jay Morris Ungar, MD
• Elizabeth E Walker, MA
• Meredith Wall, PA-C
• Gina Warren, NTP, RWP
• Corie Washow
• Tina Weaver, PT

• Pediatric Nurse Practitioner in Freeport, ME
• Providers in Freeport, ME by specialty
• Pediatric Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.