Jennifer Cherry Waggoner, CRNA
Nurse Anesthetist, Certified Registered in Winston Salem, NC. Individual provider (NPI-1).
NPI number1669997201
StatusActive
Last updated in NPPESAug 25, 2025
Details
- NPI
- 1669997201
- Entity type
- Individual (NPI-1)
- Name
- Jennifer Cherry Waggoner
- Credential
- CRNA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 4, 2017
- Certification date
- Aug 25, 2025
- Last updated
- Aug 25, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 5716 | NC | Yes |
| 367500000X | Nurse Anesthetist, Certified Registered | 239951 | NC |
Practice location
145 Kimel Park Dr Ste 120Winston Salem, NC 27103-6983
Phone 336-768-3212 · Fax 336-768-9019
Mailing address
145 Kimel Park Dr Ste 120Winston Salem, NC 27103-6983
Phone 336-768-3212 · Fax 336-768-9019
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