JENNY WAGNER

Nurse Practitioner

Active Individual
NPI: 1063885556

Practice Address

100 NE RANDOLPH AVE
Peoria, IL 61606

Phone: (309) 624-8500

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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