Healthcare Provider Details

I. General information

NPI: 1740108109
Provider Name (Legal Business Name): FELICA WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 E 19TH ST
DES MOINES IA
50316-2708
US

IV. Provider business mailing address

1005 25TH ST SE
ALTOONA IA
50009-7830
US

V. Phone/Fax

Practice location:
  • Phone: 303-242-6661
  • Fax:
Mailing address:
  • Phone: 515-314-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: