Individual
JACQUELIN K WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 274-4779
(317) 948-9806
Mailing address
PO BOX 778912, CHICAGO, IL 60677-8912
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
28230172A
IN
363LN0000X
Neonatal Nurse Practitioner
Primary
71015787A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300097824
—
IN
Enumeration date
10/01/2024
Last updated
11/04/2024
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