Monica Ann Wagner, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

345039 Issued in WI

Practice address

1630 Commanche Ave
Green Bay, WI 54313-5753

Phone

(920) 430-4750

Fax

(920) 430-4746

NPI assigned

Sep 23, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366438335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8069 COUNTY ROAD A",
            "city": "LENA",
            "state": "WI",
            "postal_code": "541399737",
            "telephone_number": "920-842-3280",
            "fax_number": "920-430-4746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 COMMANCHE AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543135753",
            "telephone_number": "920-430-4750",
            "fax_number": "920-430-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MONICA",
        "middle_name": "ANN",
        "credential": "LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "345039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather J. Wade Newell, MD
• William Joseph Wadzinski, MD
• Elizabeth Ann Waerzeggers, MPT
• Elizabeth A Wagner, NP
• Matthew Robert Wagner, DMD
• Nolan Wagner, LAT
• Patrick Nathan Wagner, M.D.
• Robert Harold Wagner, DDS
• Sage Wagner, MS, LCGC
• Samuel Wagner, DC

• Athletic Trainer in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Athletic Trainer in Wisconsin

• 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.

Verify at the official NPI Registry.