MRS. JESSICA LACHELLE WAGNER GREGG (NPI# 1033740980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1033740980 |
Entity Type | Individual |
Full Name | MRS. JESSICA LACHELLE WAGNER GREGG |
Other Name | MS. JESSICA LACHELLE WAGNER |
Credential | MSN, CRNP, CPNP-AC |
Practice Address |
22 S Greene St Baltimore MD 21201-1590 |
Mailing Address |
621 S Paca St Baltimore MD 21230-2411 |
Practice Telephone | 4103288667 |
Mailing Telephone | 5616857782 |
Enumeration Date | 2020-01-29 |
Last Update Date | 2020-01-29 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
AC002979 | MD | Allopathic & Osteopathic Physicians |
Street Address |
22 S GREENE ST |
City | BALTIMORE |
State | MD |
Zip Code | 21201-1590 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1750383063 | Malinda Daniel Duke | Nurse Practitioner | 22 S Greene St, Rm N6w84, Baltimore, MD 21201-1544 | 2005-06-01 |
1891396784 | Tamara Wiseman | Nurse Practitioner | 22 S Greene St, Baltimore, MD 21201-1544 | 2020-11-05 |
1063012664 | Shawna Marie Hutton | Registered Nurse | 22 S Greene St, Baltimore, MD 21201-1590 | 2020-11-01 |
1124625413 | Kerry Ann Lambert | Pharmacist | 22 S Greene St, Baltimore, MD 21201-1590 | 2020-10-08 |
1730786104 | Joseph William Russo | Pediatrics | 22 S Greene St, Baltimore, MD 21201-1590 | 2020-10-07 |
1295342327 | Leah Marie Dubose | Nurse Practitioner | 22 S Greene St, Baltimore, MD 21201-1544 | 2020-09-23 |
1275147167 | Rosalynn Joy Allen | Registered Nurse | 22 S Greene St, Baltimore, MD 21201-1590 | 2020-09-08 |
1174137269 | Keiara Williams | Nurse Practitioner | 22 S Greene St, Baltimore, MD 21201-1544 | 2020-09-04 |
1699389858 | Caitlin Lauren Thomas | Nurse Practitioner | 22 S Greene St, Baltimore, MD 21201-1544 | 2020-09-04 |
1639782568 | Anna Pfouts | Nurse Practitioner | 22 S Greene St, Baltimore, MD 21201-1544 | 2020-08-29 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518585470 | Meshref Ayed Alshehri | Student in an Organized Health Care Education/Training Program | 22 S. Greene Street, Room N3e09, Baltimore, MD 21201 | 2020-07-08 |
1306462411 | Michael Julian Wong | Student in an Organized Health Care Education/Training Program | University of Maryland, Department of Anesthesiology, 22 S Green St, S11b, Baltimore, MD 21201 | 2020-06-24 |
1740817733 | Martha Kaitlyn Coghlan | Student in an Organized Health Care Education/Training Program | Ummc Ob/gyn, 22 S. Greene St., Baltimore, MD 21201 | 2020-03-27 |
1629606637 | Taylor Renee Kai | Student in an Organized Health Care Education/Training Program | University of Maryland, 22 S. Greene Street, Room N3e09, Baltimore, MD 21201 | 2020-03-27 |
1295362697 | Brittany A Oster | Student in an Organized Health Care Education/Training Program | 110 S. Paca Street 6th Floor, Suite 300, Baltimore, MD 21201 | 2020-03-25 |
1346877735 | Kayvon Michael Mobarakeh | Student in an Organized Health Care Education/Training Program | University of Maryland Department of Anesthesiology, 22 S Greene St, S11c, Baltimore, MD 21201 | 2020-03-25 |
1598392284 | Zachary Allan Hagen | Student in an Organized Health Care Education/Training Program | 110 S. Paca Street, 6th Flr., Suite 200, Baltimore, MD 21201 | 2020-03-24 |
1700430055 | Jaime Semchuk | Student in an Organized Health Care Education/Training Program | 737 West Lombard, Baltimore, MD 21201 | 2019-07-25 |
1952861619 | Zachary Daniel Sanford | Student in an Organized Health Care Education/Training Program | 22 S Greene Street S8b12, Baltimore, MD 21201 | 2019-03-20 |
1114487840 | Spencer Sykes Lovegrove | Student in an Organized Health Care Education/Training Program | 110 S. Paca Street, Sixth Floor, Suite 200, Baltimore, Sixth Floor, Suite 200, Baltimore, MD 21201 | 2019-03-20 |
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Taxonomy Code | 2080P0203X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Pediatric Critical Care Medicine |
A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316572175 | Sarah Branigan | Pediatrics | Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287 | 2020-03-11 |
1891333969 | Jaime Esbensen Doroba | Pediatrics | 1800 Orleans St, Baltimore, MD 21287-0010 | 2019-12-19 |
1083032346 | Marie Emeline Pierre Louis | Pediatrics | 2401 W Belvedere Ave, Baltimore, MD 21215-5216 | 2014-04-03 |
1316280001 | Natalie S Torres-feliz | Pediatrics | 22 S Greene St, Baltimore, MD 21201-1544 | 2013-04-01 |
1346545183 | Osei Kofi Owusu | Pediatrics | 2401 W Belvedere Ave, Baltimore, MD 21215-5216 | 2011-01-25 |
1508009291 | Elizabeth Winans Tucker | Pediatrics | 1800 Orleans St, Baltimore, MD 21287-0010 | 2009-04-11 |
1902077555 | Chinyere Egbuta | Pediatrics | 600 N Wolfe St, Baltimore, MD 21287-0005 | 2008-03-21 |
1366571697 | Steven R Coleman | Pediatrics | 22 S Greene St, Baltimore, MD 21201-1544 | 2007-03-04 |
1194862102 | Melania M Bembea | Pediatrics | 600 N Wolfe St, Blalock 904, Baltimore, MD 21287-0005 | 2007-01-31 |
1972649465 | Jason Wayne Custer | Pediatrics | 22 S Greene St, Dept of Pediatric Critical Care Medicine, Baltimore, MD 21201-1544 | 2007-01-30 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.