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Individual

MRS. JESSICA LACHELLE WAGNER GREGG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, CRNP, CPNP-AC

Contact information

Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1590
(410) 328-8667
Mailing address
6651 MAIN ST STE E1420, HOUSTON, TX 77030-2432
(832) 826-6240

Taxonomy

Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
AC002979
MD
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
1076101
TX
363LP0222X
Critical Care Pediatric Nurse Practitioner
R214732
MD

Other

Enumeration date
01/29/2020
Last updated
11/17/2025
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