JACQUELINE LEE WAGNER (NPI# 1447598362) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447598362 |
| Entity Type | Individual |
| Full Name | JACQUELINE LEE WAGNER |
| Other Name | JACQUELINE LEE CRUZ-AEDO |
| Credential | ARNP |
| Practice Address |
1713 E Sherman Ave Coeur D Alene ID 83814-5326 |
| Practice Telephone | 2089664087 |
| Practice Fax Number | 2089664031 |
| Mailing Telephone | 2089664087 |
| Mailing Fax Number | 2089664031 |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2016-08-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | NP1283A | ID | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366849473 | Jacqueline Nicole Wagner | Social Worker | 1613 M 139, Benton Harbor, MI 49022-5748 | 2014-12-04 |
| 1104131648 | Jacqueline Wagner | Speech-Language Pathologist | 1640 N Wells St, Suite 103, Chicago, IL 60614-6087 | 2010-08-09 |
| 1861646010 | Jacqueline Rae Wagner | Occupational Therapist | 5842 Hobe Ln, White Bear Lake, MN 55110-4183 | 2008-11-13 |
| Street Address |
1713 E SHERMAN AVE |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-5326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154689727 | Monarch Mental Health | Community/Behavioral Health | 1713 E Sherman Ave, Coeur D Alene, ID 83814-5326 | 2012-05-02 |
| 1194064980 | Roxanne Bell | Counselor | 1713 E Sherman Ave, Coeur D Alene, ID 83814-5326 | 2013-02-14 |
| 1295095578 | Lanette Gay Livingston-clark | Counselor | 1713 E Sherman Ave, Coeur D Alene, ID 83814-5326 | 2012-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861867426 | Meza Consulting LLC | Family Medicine | 1103 E Best Ave Ste C, Coeur D Alene, ID 83814-4878 | 2015-12-08 |
| 1417210790 | Alicia Gustafson | Family Medicine | 700 W Ironwood Dr Ste 120, Coeur D Alene, ID 83814-4405 | 2012-06-21 |
| 1730311531 | Donald K Williams Do PC | Family Medicine | 2005 Ironwood Pkwy Ste 105, Coeur D Alene, ID 83814-2647 | 2009-08-13 |
| 1831393461 | Irwin H. Steiger | Family Medicine | 2610 E Spyglass Ct, Coeur D Alene, ID 83815-7946 | 2007-06-14 |
| 1730395310 | Brittany Carleton Burns | Family Medicine | 110 E Wallace Ave, Coeur D Alene, ID 83814-2948 | 2007-05-14 |
| 1821180134 | Douglas Sean Linford | Family Medicine | 566 W Prairie Ave, Coeur D Alene, ID 83815-7766 | 2006-09-28 |
| 1699879072 | Dana L Colbert | Family Medicine | 980 W Ironwood Dr Ste 201, Coeur D Alene, ID 83814-2668 | 2006-09-07 |
| 1528177151 | Mclane Andrew Simpson | Family Medicine | 5789 N La Rochelle Dr, Coeur D Alene, ID 83815-9147 | 2006-08-29 |
| 1114937661 | Carolyn Kay Wickenkamp | Family Medicine | 8795 W Driftwood Dr, Coeur D Alene, ID 83814-9602 | 2006-08-08 |
| 1932122827 | Lakeland Family Medicine Pa | Family Medicine | 1404 E Sherman Ave, Coeur D Alene, ID 83814-4044 | 2006-07-25 |
| Find all providers in COEUR D ALENE | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
Please comment or provide details below to improve the information on JACQUELINE LEE WAGNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.