Individual
BREANNA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 BURNET AVE, ML 2023, CINCINNATI, OH 45229
(513) 636-4371
(513) 636-7657
Mailing address
4975 TWINBROOK CT, BLUE ASH, OH 45242-5722
(419) 631-7256
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0035446
OH
Other
Enumeration date
12/28/2023
Last updated
03/01/2024
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