Individual
JODI ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3112 EGRE RD, SUN PRAIRIE, WI 53590-9472
(608) 265-7601
Mailing address
3112 EGRE RD, SUN PRAIRIE, WI 53590-9472
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
89156
WI
Other
Enumeration date
03/18/2006
Last updated
04/18/2024
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