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1376251009
JACOB BRADLEY WAGNER
MADISON, TN
NPI
1376251009
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
163WC0200X Registered Nurse, Critical Care Medicine
(Licence: TN 267408)
Enumeration Date
2022-11-11
Last Update Date
2022-11-11
Business Address
JACOB BRADLEY WAGNER
315 HOSPITAL DR
MADISON, TN 37115-5030
Phone number: 615-732-7662
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Mailing Address
JACOB BRADLEY WAGNER
315 HOSPITAL DR
MADISON, TN 37115-5030
Phone number: 615-732-7662
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