Provider Demographics
NPI:1144928763
Name:WAGNER, KAMERIN (CLC)
Entity type:Individual
Prefix:
First Name:KAMERIN
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:KAMERIN
Other - Middle Name:
Other - Last Name:O'NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CLC
Mailing Address - Street 1:321 W MENDENHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3446
Mailing Address - Country:US
Mailing Address - Phone:406-200-8548
Mailing Address - Fax:
Practice Address - Street 1:321 W MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3446
Practice Address - Country:US
Practice Address - Phone:406-200-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula