Healthcare Provider Details

I. General information

NPI: 1598656662
Provider Name (Legal Business Name): DENISE MARAGOS WAGNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ROSS AVE STE 1200
DALLAS TX
75201-7943
US

IV. Provider business mailing address

236 E STANTON AVE
COLUMBUS OH
43214-1236
US

V. Phone/Fax

Practice location:
  • Phone: 614-302-0277
  • Fax:
Mailing address:
  • Phone: 614-302-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN.283830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: