| Doctor Name: | PAULA J WAGNER |
| NPI Number: | 1124331152 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 209008086 |
| Business Practice Address: | 11200 Lincoln Hwy Mokena, IL - 604488208 |
| Business Phone Number: | 3123431398 |
| Business Fax Number: | |
| Mailing Address: | 1404 Greenleaf St, EVANSTON |
| State: | IL |
| Postal Code: | 602021155 |
| Phone Number: | 3123431398 |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2010 |
| NPI Last Update Date: | 03/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209008086 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |