Provider Demographics
NPI:1144046228
Name:WAGNER, LINDSEY RENEE (RN)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:RENEE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 12TH ST W APT 302
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6790
Mailing Address - Country:US
Mailing Address - Phone:406-595-8981
Mailing Address - Fax:
Practice Address - Street 1:766 ELKS DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2915
Practice Address - Country:US
Practice Address - Phone:701-483-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR55396163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse