Individual
JAKE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
550 S JACKSON ST # A3K00, LOUISVILLE, KY 40202-1622
(502) 852-4277
Mailing address
550 S JACKSON ST # A3K00, LOUISVILLE, KY 40202-1622
(502) 852-4277
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/29/2022
Last updated
03/29/2022
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