Individual
JACQUELYN CHRISTINE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 S SANTA FE AVE, SUITE 100, SALINA, KS 67401-4189
(785) 825-2273
(785) 825-2275
Mailing address
501 S SANTA FE AVE, SUITE 100, SALINA, KS 67401-4189
(785) 825-2273
(785) 825-2275
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
04-46272
KS
208000000X
Pediatrics Physician
0446272
KS
208000000X
Pediatrics Physician
R77391
AZ
208M00000X
Hospitalist Physician
04-46272
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004822670001
—
KS
Enumeration date
04/26/2019
Last updated
09/08/2022
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