1679032163 NPI number — ANGELA MICHELLE WAGNER PMHNP-BC

Table of content: ANGELA MICHELLE WAGNER PMHNP-BC (NPI 1679032163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679032163 NPI number — ANGELA MICHELLE WAGNER PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGNER
Provider First Name:
ANGELA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679032163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7723 TYLERS PLACE BLVD # 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45069-4684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-360-8089
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7723 TYLERS PLACE BLVD # 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45069-4684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-360-8089
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  APRNCNP0234 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 5011542 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN.CNP.023469 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2018009202 . This is a "ANCC - BOARD CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5011542 . This is a "NORTH CAROLINA STATE BOARD OF NURSING - ADVANCED PRACTICE LICENSE #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: APRN.CNP.023469 . This is a "OHIO BOARD OF NURSING ADVANCED PRACTICE LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".