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NPI Code Detail

MEDICARE: EMILY CHRISTINE WAGNER FNP-BC

MEDICARE: EMILY CHRISTINE WAGNER FNP-BC
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
1363LS0200XSchool Nurse Practitioner4704376428MI

General Provider Information

NPI Number : 1265391056
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY CHRISTINE WAGNER FNP-BC
Provider Business Mailing Address
First Line : 7643 DUTCHER RD
Second Line :
City : FAIRGROVE
State : MI
Zip : 48733-9754
Country : US
Telephone Number : 989-528-0838
Fax Number :
Provider Business Practice Location Address
First Line : 100 WASHINGTON AVE S STE 1210
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 866-492-5336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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