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General NPI Number Information
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NPI Number | 1053923052
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Entity Type | Individual
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Provider Name | JACLYN VANWAGNER MSN APRN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 11406 GEORGIA AVE STE F
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City | WHEATON
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State | MD
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Zip | 20902-1944
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Country | US
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Telephone | 301-200-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N ADAMS ST
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City | ROCKVILLE
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State | MD
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Zip | 20850-2217
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Country | US
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Telephone | 301-857-7758
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R206681
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License Number State | MD
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