Individual
JAMIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1243 S CEDAR CREST BLVD, ALLENTOWN, PA 18103-6268
(610) 402-5000
Mailing address
2100 MACK BLVD FL 4, ALLENTOWN, PA 18103-5622
(484) 884-4500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
SP023496
PA
363LF0000X
Family Nurse Practitioner
F01211375
PA
363LF0000X
Family Nurse Practitioner
Primary
SP023496
PA
Other
Enumeration date
04/11/2021
Last updated
11/05/2024
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