Healthcare Provider Details

I. General information

NPI: 1700553781
Provider Name (Legal Business Name): SHAYNA WAGLER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S US HIGHWAY 231
JASPER IN
47546-3299
US

IV. Provider business mailing address

357 S US HIGHWAY 231
JASPER IN
47546-3299
US

V. Phone/Fax

Practice location:
  • Phone: 812-624-8551
  • Fax: 800-878-4308
Mailing address:
  • Phone: 812-259-1249
  • Fax: 800-878-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71011487A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: