Individual
JESSICA NOEL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
12828 S 3600 W STE 101, RIVERTON, UT 84065-6853
(480) 316-2501
Mailing address
12517 S TERRAMEER AVE, HERRIMAN, UT 84096-5404
(480) 316-2501
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9073204-4405
UT
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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