Karen M Wagner, RN MSN CPNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704166418 Issued in MI

Practice address

5024 N Royal Drive
Traverse City, MI 49684

Phone

(231) 935-0555

Fax

(231) 935-0562

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner, Registered Nurse

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365120000000",
    "number": "1962597765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849230",
            "telephone_number": "231-935-0555",
            "fax_number": "231-935-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DRIVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-935-0555",
            "fax_number": "231-935-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KAREN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "RN MSN CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2013-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704166418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daryn McKenzy Waddell
• Adrienne B Wagner, D.O.
• Amy Wagner, RN
• Betty Louise Wagner, LCSW
• Hunter Wagner
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Leah Walbridge, MD
• Thomas Walbridge, DO
• Cheryl Ann Walch

• All providers in Traverse City, MI
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2013; 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.