Wagner, Donnelle I.

Wagner, Donnelle I. is an individual health care provider with primary practice located at 3700 Cliff Dr , Fort Smith AR 72903-5954. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wagner, Donnelle I. can be contacted via phone (479) 709-7260.

Contact Information

Primary practice address
3700 Cliff Dr Fort Smith AR 72903-5954
Fax: (479) 709-7261
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X ATP000123 Arkansas

Profile Details

NPI number 1225213812
LBN Legal business name Wagner, Donnelle I.
Credentials DNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 2nd, 2008
Last updated Sep 22nd, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225213812 NPPES
Arkansas MEDICAID 168334758
Arkansas MEDICAID 200130940A

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