Individual
JERICA WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
646 CHESAPEAKE ST SE, WASHINGTON, DC 20032-3652
(202) 579-3216
Mailing address
1611 ECKINGTON PL NE APT JU535, WASHINGTON, DC 20002-2699
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
12/20/2023
Last updated
12/27/2023
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