Susan Rae Wagner, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024173497 Issued in VA

Practice address

142 Highland Dr
Lebanon, VA 24266-4636

Phone

(276) 762-7600

NPI assigned

Apr 27, 2016

Last updated

Apr 27, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461715200000",
    "number": "1346695301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 PEACEFUL ST",
            "city": "CLINTWOOD",
            "state": "VA",
            "postal_code": "242285081",
            "telephone_number": "276-220-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 HIGHLAND DR",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242664636",
            "telephone_number": "276-762-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SUSAN",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024173497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ultra Health Lebanon
• Rebecca Varney, FNP
• Laura Hankins Vencill, MS CCC-SLP
• Holly Elizabeth Vicars, DO
• Virginia Department of Health (Russell County Health Department)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3480)
• Wal-Mart Stores East, LP (Vision Center 30-3480)
• Walgreen Co (Walgreens #17362)
• Robert Wayne Weatherly, PT
• Wellmont Medical Associates, Inc. (Ballad Health Medical Associates)

• Family Nurse Practitioner in Lebanon, VA
• Providers in Lebanon, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.

Verify at the official NPI Registry.