Individual
JESSICA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
335 GLESSNER AVE, MANSFIELD, OH 44903-2269
(567) 241-7000
(567) 241-7523
Mailing address
PO BOX 7527, DUBLIN, OH 43017-0727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004235
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120796
—
OH
Enumeration date
02/26/2015
Last updated
11/25/2024
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