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General NPI Number Information
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NPI Number | 1730635566
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Entity Type | Individual
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Provider Name | JEANNENE ROCHELLE WAGNER CNP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 5320 N LOVINGTON HWY
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City | HOBBS
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State | NM
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Zip | 88240-9139
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Country | US
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Telephone | 575-392-1973
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Fax | 575-392-2030
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Provider Business Mailing Address
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Address Line | 2215 NASHVILLE AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1105
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Country | US
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Telephone | 806-725-5844
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Fax | 806-723-6532
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | R26431
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 03552
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License Number State | NM
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