MEDICARE: AMY ELIZABETH WAGNER CNP

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	363LA2200X	Adult Health Nurse Practitioner	A18249	SC
2	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.0034631	OH

General Provider Information

NPI Number	:	1760556856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELIZABETH WAGNER CNP

Provider Business Mailing Address
First Line	:	625 EDEN PARK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-6005
Country	:	US
Telephone Number	:	513-246-9155
Fax Number	:	513-487-4683

Provider Business Practice Location Address
First Line	:	625 EDEN PARK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-6005
Country	:	US
Telephone Number	:	513-246-9155
Fax Number	:	513-487-4683

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	01/27/2025

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