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NPI Code Detail

MEDICARE: SHANE WAGERS

MEDICARE: SHANE WAGERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1194100545
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE WAGERS
Provider Business Mailing Address
First Line : 5138 NORTH JULIANO ROAD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149
Country : US
Telephone Number : 702-348-5547
Fax Number :
Provider Business Practice Location Address
First Line : 5138 N JULIANO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4110
Country : US
Telephone Number : 702-348-5547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2015
Last Update Date : 07/28/2015

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