Provider Demographics
NPI:1467347187
Name:WAGNER, ASHLEY REINALDA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REINALDA
Last Name:WAGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 41 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68972-5121
Mailing Address - Country:US
Mailing Address - Phone:402-767-0645
Mailing Address - Fax:
Practice Address - Street 1:573 41 1/2 RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:NE
Practice Address - Zip Code:68972-5121
Practice Address - Country:US
Practice Address - Phone:402-767-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide