Active NPI
Jodi Ann Wagner, CNM
- Advanced Practice Midwife
- Sun Prairie, WI
National Provider Identifier
1750340899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- 89156
- Practice address
- 3112 Egre Rd
Sun Prairie, WI 53590-9472 - Phone
- (608) 265-7601
- NPI assigned
- Mar 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 |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 89156 | WI | Primary |
Addresses
Primary practice location
3112 Egre Rd
Sun Prairie, WI 53590-9472
Mailing address
3112 Egre Rd
Sun Prairie, WI 53590-9472
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 Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89156 | WI | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713398400000",
"number": "1750340899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3112 EGRE RD",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535909472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3112 EGRE RD",
"city": "SUN PRAIRIE",
"state": "WI",
"postal_code": "535909472",
"telephone_number": "608-265-7601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JODI",
"middle_name": "ANN",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-18",
"last_updated": "2024-04-18",
"certification_date": "2024-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "WI",
"license": "89156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sun Prairie, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.