Individual
JENA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
561 SUMMER BLVD APT 303, LAKEMOOR, IL 60051-6641
(847) 650-8958
Mailing address
561 SUMMER BLVD APT 303, LAKEMOOR, IL 60051-6641
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041508241
IL
363LF0000X
Family Nurse Practitioner
Primary
209.035260
IL
Other
Enumeration date
12/09/2025
Last updated
04/11/2026
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