Healthcare Provider Details

I. General information

NPI: 1699199919
Provider Name (Legal Business Name): VALERIE ANN WAGNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 6TH AVE SE STE 1
ABERDEEN SD
57401-4950
US

IV. Provider business mailing address

1409 6TH AVE SE STE 1
ABERDEEN SD
57401-4950
US

V. Phone/Fax

Practice location:
  • Phone: 605-250-1200
  • Fax: 855-538-3145
Mailing address:
  • Phone: 605-250-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200471
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR-135369-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: