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General NPI Number Information
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NPI Number | 1144124314
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Entity Type | Individual
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Provider Name | NIKOLE RAE WAGNER
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Gender | Female
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 10506 BURT CIR
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City | OMAHA
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State | NE
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Zip | 68114-2094
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Country | US
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Telephone | 402-991-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 15418 BEMIS CIR
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City | OMAHA
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State | NE
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Zip | 68154-3747
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Country | US
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Telephone | 402-206-5092
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 117270
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License Number State | NE
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