Active NPI
Fean Wagner, ATHLETIC TRAINER
- Athletic Trainer
- Viroqua, WI
National Provider Identifier
1356916407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 608-39
- Practice address
- 507 S Main St
Viroqua, WI 54665-2059 - Phone
- (608) 637-2101
- NPI assigned
- May 21, 2021
- Last updated
- May 21, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 608-39 | WI | Primary |
Addresses
Primary practice location
507 S Main St
Viroqua, WI 54665-2059
Mailing address
507 S Main St
Viroqua, WI 54665-2059
Phone (608) 637-2101
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 608-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621555200000",
"number": "1356916407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 S MAIN ST",
"city": "VIROQUA",
"state": "WI",
"postal_code": "546652059",
"telephone_number": "608-637-2101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "507 S MAIN ST",
"city": "VIROQUA",
"state": "WI",
"postal_code": "546652059",
"telephone_number": "608-637-2101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "FEAN",
"credential": "ATHLETIC TRAINER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-21",
"last_updated": "2021-05-21",
"certification_date": "2021-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "608-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Viroqua, WI
- Vernon Memorial Hospital Assn
- Viroqua Area School District
- Derek Waddell, PT, DPT
- Alexander Donald Wade, M.D.
- Anna C Wagner, RD
- Wal-Mart Stores East LP (Walmart Pharmacy 10-0971)
- Wal-Mart Stores East, LP (Vision Center 30-0971)
- Walgreen Co (Walgreens #10301)
- Eric John Walker, PHARMD
- Trisha Ann Wastlick, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.