1. Home
  2. Directory
  3. Illinois
  4. Decatur
  5. Nurse Practitioner
  6. NPI Profile

MRS. CAROLYN WAGNER NP
NPI 1366419087
Nurse Practitioner - Family in Decatur, IL

Active since March 01, 2006
1770 E LAKE SHORE DR, SUITE 207, DECATUR, IL 62521(217) 429-9700(217) 429-9702 Get Directions Write a Review

NPPES record last updated: March 10, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mrs. Carolyn Wagner Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. CAROLYN WAGNER NP (NPI 1366419087) is an individual family provider in Decatur, Illinois, licensed in Illinois (209-001389) and active in the NPI registry since March 2006.

NPPES Registry Identity

NPI1366419087
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. CAROLYN WAGNERCredential: NP
Location Address1770 E LAKE SHORE DR, SUITE 207Decatur, IL 62521-3832
Mailing Address1770 E Lake Shore Dr, Suite 207Decatur, IL 62521-3832 · (217) 429-9700 · Fax (217) 429-9702
Phone(217) 429-9700
Fax(217) 429-9702
Sole ProprietorNo
Enumeration DateMarch 1, 2006
Last NPPES UpdateMarch 10, 2011
✔ NPI 1366419087 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209-001389
1770 E LAKE SHORE DR, Decatur, IL 62521
Open in Google Maps ↗

Other Identifiers 2

Medicare PINK07753
Medicare UPINS64860

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Urology
1770 E LAKE SHORE DR, SUITE 202
DECATUR, IL 62521
Macon County (217) 464-2505
DR. AHMAD H AHMAD M.D.
Internal Medicine
1770 E LAKE SHORE DR, SUITE 201
DECATUR, IL 62521
Macon County (217) 428-7921
LAUREL A WALTON DO SC
Obstetrics & Gynecology
1770 E LAKE SHORE DR, STE 309
DECATUR, IL 62521
Macon County (217) 422-9740
DEBRA G. CHARVERON LCPC
Counselor (Professional)
1770 E LAKE SHORE DR
DECATUR, IL 62521
Macon County (217) 429-9700
AZHAR ASLAM MD LLC
Otolaryngology (Otolaryngology/Facial Plastic Surgery)
1770 E LAKE SHORE DR, SUITE 103
DECATUR, IL 62521
Macon County (217) 422-9036
MS. KAREN L HAMMOND MSW LCSW
Social Worker (Clinical)
1770 E LAKE SHORE DR, SUITE 209
DACATUR, IL 62521
Macon County (217) 428-0600
DECATUR PEDIATRIC CLINIC
Pediatrics
1770 E LAKE SHORE DR
DECATUR, IL 62521
Macon County (217) 423-8800
DECATUR HEALTHCARE LLC
Clinic/Center (Ambulatory Surgical)
1770 E LAKE SHORE DR
DECATUR, IL 62521
Macon County (217) 424-1021

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Carolyn Wagner's NPI number?

The NPI number for Carolyn Wagner is 1366419087. It was assigned to this individual provider in the NPPES registry on March 1, 2006.

Where is Carolyn Wagner located?

Carolyn Wagner practices at 1770 E Lake Shore Dr Suite 207, Decatur, IL 62521. The listed phone number is (217) 429-9700.

What is Carolyn Wagner's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Carolyn Wagner was last updated on March 10, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.