MEDICARE: ERIN L WAGNER-HAGGERTY CRNP

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
1	363LF0000X	Family Nurse Practitioner	F0714723	PA

General Provider Information

NPI Number	:	1225439912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN L WAGNER-HAGGERTY CRNP

Provider Business Mailing Address
First Line	:	1624 PACIFIC AVE STE B
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2145
Country	:	US
Telephone Number	:	724-226-3455
Fax Number	:	724-226-2415

Provider Business Practice Location Address
First Line	:	1624 PACIFIC AVE STE B
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2145
Country	:	US
Telephone Number	:	724-226-3455
Fax Number	:	724-226-2415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	10/15/2020

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