Individual
JORDAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1117 E DEVONSHIRE AVE, HEMET, CA 92543-3083
(951) 652-2811
Mailing address
3477 AMBER LN, OCEANSIDE, CA 92056-4844
(775) 450-7238
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
269194
AZ
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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