Jacquleyn Wagner
Nurse Practitioner - Neonatal
300 W Clarendon Ave 375
Phoenix
, Arizona 85013-3420
Jacquleyn Wagner
Nurse Practitioner - Neonatal
300 W Clarendon Ave 375
Phoenix
, Arizona 85013-3420
(602) 274-3394
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About
Features
Specialties
- Nurse Practitioner - Neonatal
Languages spoken
- English
Location
First Address
- Jacquleyn Wagner
- 300 W Clarendon Ave 375
- Phoenix, AZ
- Zip : 85013-3420
- Fax : (602) 274-3394
- Phone : (602) 277-4161
Second Address
- Jacquleyn Wagner
- 300 W Clarendon Ave 375
- Phoenix, AZ
- Zip : 85013-3420
- Fax : (602) 274-3394
- Phone : (602) 277-4161
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LN0000X | Nurse Practitioner - Neonatal | 109110 | AZ |
National Provider Identifier
| NPI | 1134149875 |
|---|---|
| Provider Name | Jacquleyn Wagner |
| First Address | Phoenix, AZ 85013-3420 |
| Second Address | Phoenix, AZ 85013-3420 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/07/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 524430 | (05) | AZ |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.