Individual provider Active NPI

Anne Marie Olsen Wagner, CNP

  • Family Nurse Practitioner
  • Winona, MN
National Provider Identifier
1437183191
Registry record updated Nov 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R1724929 Issued in MN
Practice address
859 Mankato Ave
Winona Clinic LTD
Winona, MN 55987
Phone
(507) 454-3680
Fax
(507) 457-7672
NPI assigned
Jul 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R1724929 MN Primary

Addresses

Primary practice location

859 Mankato Ave
Winona Clinic LTD
Winona, MN 55987

Mailing address

859 Mankato Ave
Winona Clinic LTD
Winona, MN 55987
Phone (507) 454-3680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060921000599 MN Practitioner - Nurse Practitioner 6901801125 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R1724929MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Winona Health Services CurrentSince Oct 1, 2009 Accepting new patients
Winona Health Services CurrentSince Oct 1, 2009 Accepting new patients
Winona Health Services Past Accepting new patients

Locations

420 E Sarnia St
Winona, MN 55987
Phone (507) 454-3680

420 E Sarnia St
Ste 2500
Winona, MN 55987

859 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

855 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258588800000",
    "number": "1437183191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 MANKATO AVE",
            "address_2": "WINONA CLINIC LTD",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "55987",
            "telephone_number": "507-454-3680",
            "fax_number": "507-457-7672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 MANKATO AVE",
            "address_2": "WINONA CLINIC LTD",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "55987",
            "telephone_number": "507-454-3680",
            "fax_number": "507-457-7672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN WAGNER",
        "first_name": "ANNE",
        "middle_name": "MARIE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2009-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R1724929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

Verify at the official NPI Registry.