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General NPI Number Information
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NPI Number | 1588587091
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Entity Type | Organization
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Legal Business Name | WAGNER PSYCHIATRY LLC
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Dates
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Enumeration Date | 08/01/2026
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Last Update Date | 08/20/2026
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Provider Practice Location Address
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Address Line | 5800 MONROE ST STE A9
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City | SYLVANIA
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State | OH
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Zip | 43560-2208
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Country | US
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Telephone | 419-452-0495
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 N HAVEN RD
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City | TOLEDO
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State | OH
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Zip | 43615-4732
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Country | US
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Telephone | 419-452-0495
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Fax | 419-273-0608
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN WAGNER
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Credential | PMHNP
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Telephone | 419-452-0495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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