Active NPI
Leann A Wages, CNS
- Psychiatry Physician
- Fargo, ND
National Provider Identifier
1396763983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- R20068
- Practice address
- 2801 University Dr S
Fargo, ND 58103-6029 - Phone
- (701) 234-5673
- Fax
- (701) 461-5372
- NPI assigned
- Jul 18, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | R20068 | ND | Primary |
Addresses
Primary practice location
2801 University Dr S
Fargo, ND 58103-6029
Mailing address
2801 University Dr S
Fargo, ND 58103-6029
Phone (701) 234-5673
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 70015 | Medicaid | ND |
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)
- Enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R20068 | ND | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350950400000",
"number": "1396763983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 UNIVERSITY DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036029",
"telephone_number": "701-234-5673",
"fax_number": "701-461-5372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 UNIVERSITY DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036029",
"telephone_number": "701-234-5673",
"fax_number": "701-461-5372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGES",
"first_name": "LEANN",
"middle_name": "A",
"credential": "CNS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2012-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ND",
"license": "R20068",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "70015",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.