Active NPI
Aimee Therese Wagonblast, ARNP
- Psychiatric/Mental Health Nurse Practitioner
- Chehalis, WA
National Provider Identifier
1992876478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- AP30007079
- Practice address
- 151 NE Hampe Way Suite B2-6
Chehalis, WA 98532 - Phone
- (360) 748-3049
- Fax
- (360) 748-2129
- NPI assigned
- Nov 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | AP30007079 | WA | Primary |
Addresses
Primary practice location
151 NE Hampe Way Suite B2-6
Chehalis, WA 98532
Mailing address
516 Sandalwood Dr SW
Olympia, WA 98502
Phone (360) 581-2646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2019 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308614400000",
"number": "1992876478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "516 SANDALWOOD DR SW",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "98502",
"telephone_number": "360-581-2646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 NE HAMPE WAY SUITE B2-6",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "98532",
"telephone_number": "360-748-3049",
"fax_number": "360-748-2129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONBLAST",
"first_name": "AIMEE",
"middle_name": "THERESE",
"name_prefix": "Ms.",
"credential": "ARNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2011-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "WA",
"license": "AP30007079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chehalis, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.