Mrs Kimberly Ann Wagner, is a
Licensed Practical Nurse based in Lebanon, Illinois. Mrs Kimberly Ann Wagner is licensed to practice in Illinois (license number 043.085404) and her current practice location is
1 Perryman St, Lebanon, Illinois. She can be reached at her office (for appointments etc.) via phone at
(618) 537-6165.
NPI number for Mrs Kimberly Ann Wagner is 1114237575 and her current mailing address is 1 Perryman St, Lebanon, Illinois. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1114237575.
Provider's Profile
Full Name | Mrs Kimberly Ann Wagner |
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Gender | Female |
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Speciality | Licensed Practical Nurse |
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Location | 1 Perryman St, Lebanon, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1114237575
- Provider Enumeration Date: 10/19/2010
- Last Update Date: 10/19/2010
Medical Identifiers
Medical identifiers for Mrs Kimberly Ann Wagner such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1114237575 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
164W00000X | Licensed Practical Nurse | 043.085404 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Kimberly Ann Wagner is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mrs Kimberly Ann Wagner, 1 Perryman St, Lebanon, IL 62254-1356 Ph: () - | Mrs Kimberly Ann Wagner, 1 Perryman St, Lebanon, IL 62254-1356 Ph: (618) 537-6165 |
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