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General NPI Number Information
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NPI Number | 1982932539
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Entity Type | Individual
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Provider Name | JEANINE CHRISTINE WAGNER FNP
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Gender | Female
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 27780 JEFFERSON AVE
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City | TEMECULA
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State | CA
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Zip | 92590-6602
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Country | US
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Telephone | 951-290-1406
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Fax |
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Provider Business Mailing Address
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Address Line | 28780 SINGLE OAK DR STE 260
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City | TEMECULA
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State | CA
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Zip | 92590-5534
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Country | US
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Telephone |
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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 | RN348218
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License Number State | OH
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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 | 20404
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License Number State | CA
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