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General NPI Number Information
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NPI Number | 1780485300
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Entity Type | Individual
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Provider Name | KIERSTON MICHELE WAGGONER BSN,RN,CEN,TCRN,CPEN
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Gender | Female
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 520 S 7TH ST
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City | VINCENNES
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State | IN
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Zip | 47591-1038
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Country | US
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Telephone | 812-885-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 906 S PRAIRIE ST
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City | ROBINSON
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State | IL
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Zip | 62454-1621
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Country | US
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Telephone | 618-554-2894
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 28232941A
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License Number State | IN
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