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NPI Code Detail

MEDICARE: MRS. LADONNA WAGNER FNP

MEDICARE:  MRS. LADONNA  WAGNER  FNP
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
1363LF0000XFamily Nurse Practitioner0024172214VA

General Provider Information

NPI Number : 1538566716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LADONNA WAGNER FNP
Provider Business Mailing Address
First Line : 8569 SUDLEY RD STE B
Second Line :
City : MANASSAS
State : VA
Zip : 20110-3866
Country : US
Telephone Number : 703-257-7749
Fax Number : 855-254-4529
Provider Business Practice Location Address
First Line : 8569 SUDLEY RD STE B
Second Line :
City : MANASSAS
State : VA
Zip : 20110-3866
Country : US
Telephone Number : 703-257-7749
Fax Number : 855-254-4529
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2014
Last Update Date : 10/06/2020

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Directions to “ MRS. LADONNA WAGNER FNP” Practice Location

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