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General NPI Number Information
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NPI Number | 1093385148
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Entity Type | Individual
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Provider Name | AMBERLY CATHERINE WAGNER-CONNOLLY DNP, MSN, RN
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Gender | Female
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 11815 SOUTH 216TH STREET
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City | GRETNA
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State | NE
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Zip | 68028
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Country | US
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Telephone | 402-659-3855
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Fax |
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Provider Business Mailing Address
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Address Line | 11815 SOUTH 216TH STREET SUITE 6
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City | GRETNA
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State | NE
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Zip | 68028
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Country | US
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Telephone | 402-659-3855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 114610
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 62147
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License Number State | NE
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