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1649000183
NATHAN ANDREW WAGNER
JACKSON, MS
NPI
1649000183
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MS 906801)
Enumeration Date
2024-08-07
Last Update Date
2024-08-07
Business Address
NATHAN ANDREW WAGNER NP
1325 E FORTIFICATION ST
JACKSON, MS 39202-2442
Phone number: 601-354-4488
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Mailing Address
NATHAN ANDREW WAGNER NP
1325 E FORTIFICATION ST
JACKSON, MS 39202-2442
Phone number: 601-354-4488
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