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Contact Information

DEBORAH B WAGENAAR, DO
909 WILSON RD RM B119
EAST LANSING, MI48824-6410
 Phone: 517-353-3070
 Fax: 517-884-1817
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Psychiatry

2084P0805X 86 Physician/Neuropsychiatry
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
Indicates primary specialty

NPI Profile & details for DEBORAH B WAGENAAR · (Female)

NPI Number 1255315628
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 11/30/2005
Last updated 06/29/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • MI License # 5101008530
  • MI Medicaid 1255315628
  • MI Medicaid 3179331
Hospital affiliation(s)
  • HARBOR BEACH COMMUNITY HOSPITAL - (Critical Access)
    210 S FIRST ST
    HARBOR BEACH, MI 48441
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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