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General NPI Number Information
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NPI Number | 1003736984
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Entity Type | Individual
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Provider Name | JENNIFER M WAGNER
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Gender | Female
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 2400 MIAMI VALLEY DR
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City | CENTERVILLE
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State | OH
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Zip | 45459-4774
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Country | US
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Telephone | 937-438-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 2862 ROCHESTER AVE
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City | FAIRFIELD TOWNSHIP
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State | OH
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Zip | 45011-0515
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Country | US
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Telephone | 513-255-4020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN.CNP.0042761
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License Number State | OH
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