MEDICARE: SARAH N WAGNER LPN

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	164W00000X	Licensed Practical Nurse	LN89799	MA

General Provider Information

NPI Number	:	1679044283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH N WAGNER LPN

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 MERRIMACK ST STE 106
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1783
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

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

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	05/09/2023

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