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Contact Information

ELLEN A WAGNER, CRNA
265 HERRICK ROAD
SOUTHAMPTON, NY11968
 Phone: 631-726-8350
 Fax: 631-726-8519
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Anesthetist, Certified Registered

367500000X 43 Certified Registered Nurse Anesthetist (CRNA)
Indicates primary specialty

NPI Profile & details for ELLEN A WAGNER · (Female)

NPI Number 1568408789
Status Active
Credentials CRNA (Certified Registered Nurse Anesthetist)
Entity Individual
Enumeration date 06/22/2006
Last updated 07/21/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 3472891
  • RI License # APRN03496
  • Other P00164249 RR MEDICARE
Hospital affiliation(s)
  • PECONIC BAY MEDICAL CENTER - (Acute Care)
    1300 ROANOKE AVENUE
    RIVERHEAD, NY 11901
  • ST CATHERINE OF SIENA HOSPITAL - (Acute Care)
    50 ROUTE 25A
    SMITHTOWN, NY 11787
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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