SAMANTHA ELIZABETH WAGNER (NPI# 1538631114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538631114 |
| Entity Type | Individual |
| Full Name | SAMANTHA ELIZABETH WAGNER |
| Credential | APRN |
| Practice Address |
209 9th St Rockford IL 61104-2235 |
| Mailing Address |
4180 Yale Dr Rockton IL 61072-3212 |
| Practice Telephone | 7796962750 |
| Mailing Telephone | 8157215303 |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2018-12-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
209.018557 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770943078 | Samantha Ann Wagner | Specialist/Technologist | 170 Athletic Ctr, Stillwater, OK 74078-0001 | 2016-02-29 |
| 1083245781 | Samantha Nicole Wagner | Behavior Technician | 1563 Kingsley Ave Ste 103, Orange Park, FL 32073-4503 | 2020-01-31 |
| 1689151391 | Samantha Wagner | Pharmacist | 410 W 10th Ave, 368 Doan Hall, Columbus, OH 43210 | 2018-07-25 |
| 1124524608 | Samantha Wagner | Social Worker | 8616 Northern Ave, Rockford, IL 61107-5309 | 2018-04-03 |
| 1013415199 | Samantha Brooke Wagner | Counselor | 3230 Waring Ct Ste A, Oceanside, CA 92056-4509 | 2018-01-24 |
| 1598272429 | Samantha Rose Wagner | Social Worker | 8261 Market St, Boardman, OH 44512-6254 | 2017-12-31 |
| 1528595394 | Samantha Louise Wagner | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2017-05-11 |
| 1508311622 | Samantha M Wagner | Registered Nurse | 191 N Main St, Wellsville, NY 14895-1150 | 2016-08-18 |
| 1134559966 | Samantha Wagner | Behavioral Analyst | 16782 Von Karman Ave Ste 11, Irvine, CA 92606 | 2013-11-14 |
| 1669801791 | Samantha Wagner | Social Worker | 30 Prospect Ave, Hackensack, NJ 07601-1914 | 2013-11-08 |
| Street Address |
209 9TH ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61104-2235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639104359 | Alta L Ryan | Nurse Practitioner | 209 9th St, Suite 200, Rockford, IL 61104-2235 | 2006-07-11 |
| 1689139388 | Amy Wedel | Occupational Therapist | 209 9th St, Rockford, IL 61104-2235 | 2019-02-06 |
| 1548754591 | Jessica Lee Driscoll | Physical Medicine & Rehabilitation | 209 9th St, Rockford, IL 61104-2235 | 2018-06-21 |
| 1346733953 | Amy L Carter | Physical Medicine & Rehabilitation | 209 9th St, Rockford, IL 61104-2235 | 2018-06-08 |
| 1659864312 | Jered Andrew Hartman | Physical Therapist | 209 9th St, Rockford, IL 61104-2235 | 2018-06-07 |
| 1669965463 | Betty Lynn Downing | Physical Therapy Assistant | 209 9th St, Rockford, IL 61104-2235 | 2018-06-07 |
| 1679066336 | Kristin Crowell Hatch | Occupational Therapist | 209 9th St, Rockford, IL 61104-2235 | 2018-06-07 |
| 1881187565 | Ray Peregrino | Physical Therapist | 209 9th St, Rockford, IL 61104-2235 | 2018-06-07 |
| 1801272836 | Laurie Hasken | Registered Nurse | 209 9th St, Suite 200, Rockford, IL 61104 | 2015-07-31 |
| 1043569247 | Thomas A Gill | Physical Therapist | 209 9th St, Rockford, IL 61104-2235 | 2012-09-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699216564 | Swedishamerican Hospital | Nutritionist | 1415 E. State St., Lower Level A3, Rockford, IL 61104 | 2017-03-13 |
| 1376950485 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 200, Rockford, IL 61104 | 2014-07-21 |
| 1871907774 | Oday Alsarraf | Psychiatry & Neurology | 1401 E State Street, Center for Mental Health, Swedish American Hospital, Rockford, IL 61104 | 2014-06-18 |
| 1962652339 | Children's Home and Aid | Community/Behavioral Health | 424 7th St, Rockford, IL 61104 | 2008-09-23 |
| 1689729535 | Swedishamerican Hospital | Nurse Practitioner | 1340 Charles St Ste 100, Rockford, IL 61104 | 2007-01-23 |
| 1790873016 | David J Schleicher | Obstetrics & Gynecology | 209 9th St Ste 200, Rockford, IL 61104 | 2006-10-11 |
| 1013026624 | Thomas Ryan Moss | Dentist | 1415 E State Street, Rockford, IL 61104 | 2006-08-29 |
| 1366452096 | Arturo Santiago Manas | Obstetrics & Gynecology | 1415 E State St Fl 8, Rockford, IL 61104 | 2006-08-08 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1689604969 | Prabha Chand Dosi | Pediatrics | 1401 E. State Street, Rockford, IL 61104 | 2006-07-03 |
| Find all providers in zip 61104 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1982144762 | Lu Ann Ostrander | Nurse Practitioner | 2350 N Rockton Ave, Rockford, IL 61103-3600 | 2017-02-28 |
| 1992177612 | Lindsay Nagus | Nurse Practitioner | 1200 W State St, Rockford, IL 61102-2112 | 2015-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225636475 | Monika Sitko | Nurse Practitioner | 3 E 14th Pl, Lombard, IL 60148-4574 | 2020-10-10 |
| 1134735343 | Michael Fitz | Nurse Practitioner | 6205 Westminster Ct, Springfield, IL 62711-6728 | 2020-09-22 |
| 1013521038 | Eziaha R Georgewill | Nurse Practitioner | 17800 Kedzie Ave # A, Hazel Crest, IL 60429-2029 | 2020-09-08 |
| 1447870274 | 15 Park Place LLC | Nurse Practitioner | 15 Park Pl Ste 1, Swansea, IL 62226-2918 | 2020-04-22 |
| 1861021248 | Elizabeth Horan | Nurse Practitioner | 125 S Green St Apt 1005a, Chicago, IL 60607-3717 | 2020-04-07 |
| 1699315697 | Kelsey L Proehl | Nurse Practitioner | 70 Meadowview Ctr Ste 300, Kankakee, IL 60901-2062 | 2020-01-08 |
| 1992343248 | Maryanne M Smith | Nurse Practitioner | 805 W Deyoung St Ste D, Marion, IL 62959-1602 | 2019-12-17 |
| 1730724451 | Suzana None Nikitovic | Nurse Practitioner | 2815 Regner Rd, Mchenry, IL 60051-6942 | 2019-11-18 |
| 1104461870 | Swanson Family Practice LLC | Nurse Practitioner | 733 N Logan Ave Ste 1, Danville, IL 61832-4378 | 2019-11-16 |
| 1205471083 | Sylvia Coleman | Nurse Practitioner | 20 W Kinzie St Ste 17, Chicago, IL 60654-6393 | 2019-11-15 |
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| 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.