Jeannene Donna Wagner, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

324664 Issued in NY

Practice address

9 Rochester St
Scottsville, NY 14546-1331

Phone

(585) 315-8198

NPI assigned

Mar 27, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553644800000",
    "number": "1003377516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 ROCHESTER ST",
            "city": "SCOTTSVILLE",
            "state": "NY",
            "postal_code": "145461331",
            "telephone_number": "585-315-8198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 ROCHESTER ST",
            "city": "SCOTTSVILLE",
            "state": "NY",
            "postal_code": "145461331",
            "telephone_number": "585-315-8198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JEANNENE",
        "middle_name": "DONNA",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2019-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "324664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scottsville Family Medicine, LLC
• Maia Quetzal Simon, BCBA, LBA-NY
• Heather Sprague, PH.D.
• Touchstone Counseling Services, LCSW, PLLC
• Village of Scottsville
• Cynthia L Weaver, RPH
• Aaron James Weber, RPH
• Wheatland-Chili Central School District
• Heather Sue Woerner, LPN
• Jennifer Leigh Wolford, B.S., S/L THERAPIST

• Licensed Practical Nurse in Scottsville, NY
• Providers in Scottsville, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.