| NPI | 1073229076 |
|---|---|
| Former Name | JESSICA MAE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-212163) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-01-24 |