Provider Demographics
NPI:1861042392
Name:WAGY, JENNIFER ELLA (DNP, FNP-BC, NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLA
Last Name:WAGY
Suffix:
Gender:F
Credentials:DNP, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4338
Mailing Address - Country:US
Mailing Address - Phone:307-577-5100
Mailing Address - Fax:
Practice Address - Street 1:6500 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4338
Practice Address - Country:US
Practice Address - Phone:307-577-5100
Practice Address - Fax:307-233-0613
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY44650363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care