Wagner, Ellen A

Wagner, Ellen A is an individual health care provider with primary practice located at 265 Herrick Road , Southampton NY 11968. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Wagner, Ellen A can be contacted via phone (631) 726-8350.

Contact Information

Primary practice address
265 Herrick Road Southampton NY 11968
Phone: (631) 726-8350
Fax: (631) 726-8519
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 3472891 New York
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X APRN03496 Rhode Island

Profile Details

NPI number 1568408789
LBN Legal business name Wagner, Ellen A
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Jul 21st, 2023 - about 3 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 1568408789 NPPES
Other P00164249 RR MEDICARE

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