Active NPI
Monta Wagner, NP
- Family Nurse Practitioner
- Horseheads, NY
National Provider Identifier
1639101363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 330195
- Practice address
- 3344 Chambers Rd Ste 200
Horseheads, NY 14845-1403 - Phone
- (607) 734-2264
- Fax
- (607) 734-2932
- NPI assigned
- Jul 6, 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 330195 | NY | Primary |
Addresses
Primary practice location
3344 Chambers Rd Ste 200
Horseheads, NY 14845-1403
Mailing address
1 Guthrie SQ
Sayre, PA 18840-1625
Phone (607) 734-2264
Other practice location 1
302 Hoffman St
Elmira, NY 14905-2263
Phone (607) 734-2264
Other practice location 2
254 E 1st St
Corning, NY 14830-2925
Phone (607) 937-5317
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01267821 | Medicaid | NY | |
| 161355553 | Other | BUSINESS TAX ID |
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
- Nurse Practitioner
Interoperability endpoints
- mwagner136844@direct-guthrie.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614729600000",
"number": "1639101363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 GUTHRIE SQ",
"city": "SAYRE",
"state": "PA",
"postal_code": "188401625",
"telephone_number": "607-734-2264",
"fax_number": "708-885-8585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3344 CHAMBERS RD STE 200",
"city": "HORSEHEADS",
"state": "NY",
"postal_code": "148451403",
"telephone_number": "607-734-2264",
"fax_number": "607-734-2932"
}
],
"practiceLocations": [
{
"address_1": "302 Hoffman St",
"address_purpose": "LOCATION",
"city": "Elmira",
"state": "NY",
"postal_code": "149052263",
"country_code": "US",
"telephone_number": "607-734-2264",
"fax_number": "607-767-0340",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "254 E 1st St",
"address_purpose": "LOCATION",
"city": "Corning",
"state": "NY",
"postal_code": "148302925",
"country_code": "US",
"telephone_number": "607-937-5317",
"fax_number": "607-937-6254",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WAGNER",
"first_name": "MONTA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-06",
"last_updated": "2021-03-03",
"certification_date": "2021-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "330195",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01267821",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUSINESS TAX ID",
"identifier": "161355553",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Horseheads, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.