Healthcare Provider Details

I. General information

NPI: 1689950453
Provider Name (Legal Business Name): APRIL M WAGNER ARNP-FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENYON RD SUITE S
FORT DODGE IA
50501-5776
US

IV. Provider business mailing address

802 KENYON RD 513
FORT DODGE IA
50501-5740
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6800
  • Fax: 515-573-7234
Mailing address:
  • Phone: 515-574-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116257
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: