Provider Demographics
NPI:1598649063
Name:WAGNER, JADEN LILLY
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:LILLY
Last Name:WAGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2825
Mailing Address - Country:US
Mailing Address - Phone:814-493-5219
Mailing Address - Fax:
Practice Address - Street 1:413 W 2ND ST
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2825
Practice Address - Country:US
Practice Address - Phone:814-493-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula