Individual
DR. JEFFREY DAVID WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, ARNP
Contact information
Practice address
3303 SW BOND AVE, PORTLAND, OR 97239
(503) 418-9400
(503) 418-9401
Mailing address
3303 SW BOND AVE, PORTLAND, OR 97239-4501
(503) 418-9400
(503) 418-9401
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201801605NP-PP
OR
Other
Enumeration date
12/08/2016
Last updated
09/07/2018
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