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Individual

JESSICA ANN WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
2165 PROMISE RD, RAPID CITY, SD 57701-8981
(605) 718-1095
Mailing address
18696 228TH ST, WALL, SD 57790-6130
(605) 899-9177

Taxonomy

Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
R037727
SD

Other

Enumeration date
05/07/2025
Last updated
05/07/2025
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