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1114667334
JAKE WAGNER
LOUISVILLE, KY
NPI
1114667334
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2022-03-29
Last Update Date
2022-03-29
Business Address
JAKE WAGNER
550 S JACKSON ST # A3K00
LOUISVILLE, KY 40202-1622
Phone number: 502-852-4277
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Mailing Address
JAKE WAGNER
550 S JACKSON ST # A3K00
LOUISVILLE, KY 40202-1622
Phone number: 502-852-4277
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