Individual provider Active NPI

Jennifer M Wagers

  • Licensed Practical Nurse
  • Cincinnati, OH
National Provider Identifier
1417561440
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
174562 Issued in OH
Practice address
830 Ezzard Charles Dr
Cincinnati, OH 45214-2525
Phone
(513) 381-6672
NPI assigned
Sep 8, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 174562 OH Primary

Addresses

Primary practice location

830 Ezzard Charles Dr
Cincinnati, OH 45214-2525

Mailing address

8311 Wexford Ave
Cincinnati, OH 45236-1607
Phone (513) 213-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
174562OHMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1417561440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8311 WEXFORD AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452361607",
            "telephone_number": "513-213-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 EZZARD CHARLES DR",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452142525",
            "telephone_number": "513-381-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGERS",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "174562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.