Provider Demographics
NPI:1548818370
Name:WAGENBACH, LINDSEY KAYTE (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:KAYTE
Last Name:WAGENBACH
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:MRS
Other - First Name:LINDSEY
Other - Middle Name:KAYTE
Other - Last Name:HEMPHILL, DEWEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14181 BUSINESS CENTER DR NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4654
Mailing Address - Country:US
Mailing Address - Phone:763-236-0500
Mailing Address - Fax:
Practice Address - Street 1:14181 BUSINESS CENTER DR NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4654
Practice Address - Country:US
Practice Address - Phone:763-236-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6611363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health