Healthcare Provider Details

I. General information

NPI: 1467425744
Provider Name (Legal Business Name): CYNTHIA ANN WAGGY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

925 W EUCLID AVE
MARION IN
46952-3454
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-3321
  • Fax: 765-677-3972
Mailing address:
  • Phone: 765-662-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28066821A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000404A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: