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NPI Code Detail

MEDICARE: PAULA WAGNER FNP

MEDICARE: PAULA 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
1363L00000XNurse PractitionerA83339CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760467948
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA WAGNER FNP
Provider Business Mailing Address
First Line : 4860 Y ST
Second Line : SUITE 2200
City : SACRAMENTO
State : CA
Zip : 95817-2307
Country : US
Telephone Number : 916-734-8482
Fax Number : 916-734-8094
Provider Business Practice Location Address
First Line : 4860 Y ST
Second Line : SUITE 2200
City : SACRAMENTO
State : CA
Zip : 95817-2307
Country : US
Telephone Number : 916-734-8482
Fax Number : 916-734-8094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2005
Last Update Date : 07/08/2007

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Directions to “ PAULA WAGNER FNP” Practice Location

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