Individual
JENNIFER WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
37 N CHEMUNG ST, WAVERLY, NY 14892-1211
(607) 565-2861
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F340629
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02693896
—
NY
Enumeration date
11/25/2013
Last updated
04/05/2021
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