Individual
JEANNE WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 ROXBORO RD, CLEVELAND HTS, OH 44106-3624
(216) 320-3136
Mailing address
17556 FAIRLAWN DR, CHAGRIN FALLS, OH 44023-6419
(216) 320-3136
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
34778885
OH
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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