Diane Marie Wagoner, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041259607 Issued in IL

Practice address

7230 W North Ave
Elmwood Park, IL 60707-4261

Phone

(708) 453-3000

NPI assigned

Jun 10, 2008

Last updated

Jun 10, 2008By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1376703611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 W 14TH PL",
            "address_2": "UNIT 306",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082845",
            "telephone_number": "312-226-0619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 W NORTH AVE",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607074261",
            "telephone_number": "708-453-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "DIANE",
        "middle_name": "MARIE",
        "credential": "R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041259607",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28116407A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trust Medical Transport Inc
• Sara Van Trejo
• Abigail Rose Van Zee, DPT
• Village of Elmwood Park
• Mamerto S Villamonte II, D.D.S.
• Walgreen Co (Walgreens #03833)
• Walgreen Co (Walgreens #13826)
• Walgreen Co. (Walgreens #13826)
• John J Walsh, MD
• Claudia M Weddaburne, MD

• Registered Nurse in Elmwood Park, IL
• Providers in Elmwood Park, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.