Michael David Wagner, MS, RN, CNP, PMHNPBC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R247240 Issued in MD

Practice address

13719 Lapwing Way
Clarksburg, MD 20871-3401

Phone

(507) 696-2157

NPI assigned

Jul 23, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Practitioner, Master of Science, Registered Nurse

State licenses

Practice roles

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.

• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD (past)
• US Department of Justice

  • General Practice Physician
  • Rochester, MN
  • NPI 1780899518
  NPD (past)

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1699384958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13719 LAPWING WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208713401",
            "telephone_number": "507-696-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13719 LAPWING WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208713401",
            "telephone_number": "507-696-2157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "credential": "MS, RN, CNP, PMHNPBC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-23",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "191995-4",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "7558",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R247240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Unified Resource Coordination Inc.
• Jen Unruh, CNS, LDN
• Sherryl Vanlare, MS, CNS
• Visionary Eyecare Professionals
• VR Dietitian & Nutrition Consulting LLC
• Latascha Patrice Washington, LCSW-C
• Joseph Peter Wilson, L.C.S.W.-C.
• Daniel Woldetensay
• Nancy Wolfson, MPT
• Jennifer Bailing Yen, LICENSE ACUPUNCTURE

• Psychiatric/Mental Health Nurse Practitioner in Clarksburg, MD
• Providers in Clarksburg, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; 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.