Individual
JILL IRENE WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1900 SOUTH AVE, LA CROSSE, WI 54601-5467
(608) 397-3123
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
11818-33
WI
363LA2200X
Adult Health Nurse Practitioner
Primary
11818-33
WI
Other
Enumeration date
08/15/2022
Last updated
09/14/2022
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