Individual
JILL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, RCS
Contact information
Practice address
154 N 15TH AVE, WEST BEND, WI 53095-3023
(262) 334-8158
Mailing address
154 N 15TH AVE, WEST BEND, WI 53095-3023
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
154545
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35032000
—
WI
Enumeration date
05/01/2008
Last updated
05/01/2008
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