NPIMap

Individual provider Active NPI

Deborah A Wagner, P.A.-C

  • Physician Assistant
  • Mankato, MN
National Provider Identifier
1699802181
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
140806 Issued in MN
Practice address
1025 Marsh St
Mankato, MN 56001-4752
Phone
(507) 625-4032
NPI assigned
Feb 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 140806 MN Primary
Physician Assistant 363A00000X 2099 WI

Addresses

Primary practice location

1025 Marsh St
Mankato, MN 56001-4752

Mailing address

1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4032

Other practice location 1

1111 Delafield St
Suite 209
Waukesha, WI 53188-3403
Phone (262) 542-0444

Other identifiers 1

IdentifierTypeStateIssuer
41936300MedicaidWI

Other names 1

  • Miss Deborah A Manteufel Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dwagner1764142@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220727002884 MN Practitioner - Physician Assistant 0042314106 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic Health System-Southwest Minnesota RegionGroup PAC ID 4688585771, shared by 6 NPIs, 658 clinicians

Practice addresses (Care Compare)

1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4031

301 2ND St NE
New Prague, MN 56071-1709
Phone (952) 758-4431

Hospital & facility affiliations

  • Mayo Clinic Health System - Mankato Hospital, Mankato, MN, CCN 240093
  • Mayo Clinic Health System - Albert Lea and Austin Hospital, Albert Lea, MN, CCN 240043
  • North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001
  • Mayo Clinic Health System New Prague Hospital, New Prague, MN, CCN 241361
  • Mayo Clinic Health System - Waseca Hospital, Waseca, MN, CCN 241345

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
14086MNMDDentist
140806MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Dec 28, 2025 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jul 13, 2022 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Dec 28, 2025 Accepting new patients
Mayo Clinic Health System-Fairmont CurrentSince Jul 13, 2022 Accepting new patients
Mayo Clinic Health System-Lake City CurrentSince Dec 1, 2025 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Dec 28, 2025 Accepting new patients
Mayo Clinic Health System-St James CurrentSince Dec 28, 2025 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jul 13, 2022 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Dec 1, 2025 Accepting new patients
Mayo Clinic Health System-Lake City CurrentSince Dec 28, 2025 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Dec 1, 2025 Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

32021 County 24 Blvd
Cannon Falls, MN 55009
Phone (507) 263-6000

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261

501 State St N
Waseca, MN 56093
Phone (507) 835-1210

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1699802181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-625-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-625-4032"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 Delafield St",
            "address_2": "Suite 209",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531883403",
            "country_code": "US",
            "telephone_number": "262-542-0444",
            "fax_number": "262-542-8214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DEBORAH",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "140806",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2099",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41936300",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwagner1764142@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "1025 Marsh St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560014752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DEBORAH",
            "last_name": "MANTEUFEL",
            "middle_name": "A",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.