Jessica Wagner

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

578558 Issued in NY

Practice address

4802 10TH Ave
Brooklyn, NY 11219-2916

Phone

(718) 283-3071

NPI assigned

Oct 1, 2018

Last updated

Oct 1, 2018By the provider in NPPES

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

Other identifiers 1

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": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1134604648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 HARRIS LN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103091505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "578558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "163W00000X REGISTERED NURSE",
            "identifier": "578558",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Wagman
• Alexis Wagner, RRT
• Aviva Wagner
• Cheri Wagner
• Courtney Cimone Wagner, LMHC
• John D Wagner, MD, MBA
• Keisha Lynn Wagner
• Lance W. Wagner, M.D.
• Margaret Susan Wagner
• Miriam Wagner, LMSW

• Registered Nurse in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.