Individual
MOLLIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1514 JEFFERSON HWY, JEFFERSON, LA 70121-2451
(504) 842-3000
Mailing address
1514 JEFFERSON HWY, JEFFERSON, LA 70121-2451
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
887322
MS
Other
Enumeration date
03/16/2026
Last updated
03/16/2026
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