Healthcare Provider Details

I. General information

NPI: 1760535538
Provider Name (Legal Business Name): MONICA ELAINE WAGNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA ELAINE NANIA MD

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E CAMELBACK RD SUITE 175
PHOENIX AZ
85018
US

IV. Provider business mailing address

3333 E CAMELBACK RD SUITE 175
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-3120
  • Fax: 602-840-3237
Mailing address:
  • Phone: 602-840-3120
  • Fax: 602-840-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: