| Doctor Name: | NICOLE MARILYN WAGSCHAL |
| NPI Number: | 1003013525 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN APRN |
| License Number: | 005423 |
| Business Practice Address: | 3514 Main St Cvs- Minute Clinic Coventry, CT - 062381551 |
| Business Phone Number: | 8663892727 |
| Business Fax Number: | |
| Mailing Address: | 150 Balazs Rd, WILLINGTON |
| State: | CT |
| Postal Code: | 062792401 |
| Phone Number: | 8663892727 |
| Fax Number: | |
| NPI Enumeration Date: | 06/28/2007 |
| NPI Last Update Date: | 10/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 005423 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |