Active NPI
Laura L. Wagner, APRN, BC, APNP
- Gerontology Nurse Practitioner
- Madison, WI
National Provider Identifier
1356555742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 1352-033
- Practice address
- 2810 Crossroads Dr
Madison, WI 53718-7942 - Phone
- (608) 819-0033
- Fax
- (608) 819-0048
- NPI assigned
- May 9, 2007
- Last updated
- Dec 16, 2014
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 1352-033 | WI | Primary |
Addresses
Primary practice location
2810 Crossroads Dr
Madison, WI 53718-7942
Mailing address
2810 Crossroads Dr
Madison, WI 53718-7942
Phone (608) 819-0033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1352-033 | WI | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418688000000",
"number": "1356555742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 CROSSROADS DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537187942",
"telephone_number": "608-819-0033",
"fax_number": "608-819-0048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2810 CROSSROADS DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537187942",
"telephone_number": "608-819-0033",
"fax_number": "608-819-0048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LAURA",
"middle_name": "L.",
"name_prefix": "Ms.",
"credential": "APRN, BC, APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-09",
"last_updated": "2014-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "WI",
"license": "1352-033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; 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.