JENNY WAGNER
Nurse Practitioner
Active
Individual
NPI: 1063885556
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Nurse Practitioner | 363L00000X | Yes | 209.013545 (IL) |
Frequently Asked Questions
NPI 1063885556 is the National Provider Identifier for JENNY WAGNER, a Nurse Practitioner provider located in Peoria, IL. This NPI was enumerated on November 5, 2015.
JENNY WAGNER practices at 100 NE RANDOLPH AVE, Peoria, IL 61606.
Quick Facts
- NPI
- 1063885556
- Type
- Individual
- Enumerated
- Nov 5, 2015
- Last Updated
- Nov 5, 2015
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