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NPI Code Detail

MEDICARE: MR. JASON RUTLEDGE WAGNER II

MEDICARE: MR. JASON RUTLEDGE WAGNER II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747A0650XAttendant Care Provider

General Provider Information

NPI Number : 1972450682
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON RUTLEDGE WAGNER II
Provider Business Mailing Address
First Line : 8050 N 129TH AVE
Second Line :
City : OMAHA
State : NE
Zip : 68142-1804
Country : US
Telephone Number : 531-299-2340
Fax Number :
Provider Business Practice Location Address
First Line : 8050 N 129TH AVE
Second Line :
City : OMAHA
State : NE
Zip : 68142-1804
Country : US
Telephone Number : 531-299-2340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ MR. JASON RUTLEDGE WAGNER II ” Practice Location

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