Healthcare Provider Details

I. General information

NPI: 1578447306
Provider Name (Legal Business Name): REBECCA E WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 BROADWAY
SCOTTSBLUFF NE
69361-3167
US

IV. Provider business mailing address

1524 BROADWAY
SCOTTSBLUFF NE
69361-3167
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-2900
  • Fax:
Mailing address:
  • Phone: 308-635-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: