Provider Demographics
NPI:1174978282
Name:WAGNER, LINDSAY (CRNA)
Entity type:Individual
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First Name:LINDSAY
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:571-777-5106
Mailing Address - Fax:703-563-6256
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-878-8700
Practice Address - Fax:708-783-0920
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2021-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL041394642367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered