MEDICARE: BOBBI WAGNER

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	276242	PA

General Provider Information

NPI Number	:	1730027822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBI WAGNER

Provider Business Mailing Address
First Line	:	243 SCHNEIDER DR
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17046-4875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 SCHNEIDER DR
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17046-4875
Country	:	US
Telephone Number	:	717-273-8000
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ BOBBI WAGNER ” Practice Location

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