Individual
GRACE WAGERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2151 FENWAY PL, REYNOLDSBURG, OH 43068-8252
(614) 783-9886
Mailing address
2151 FENWAY PL, REYNOLDSBURG, OH 43068-8252
(614) 783-9886
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN-120198
OH
Other
Enumeration date
06/18/2009
Last updated
06/18/2009
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