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NPI Code Detail

MEDICARE: BRE ANNA MARIE NAGLE MD

MEDICARE: BRE ANNA MARIE NAGLE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician64734-20WI

General Provider Information

NPI Number : 1891112793
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRE ANNA MARIE NAGLE MD
Provider Business Mailing Address
First Line : 420 E DIVISION ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-4560
Country : US
Telephone Number : 920-926-8343
Fax Number :
Provider Business Practice Location Address
First Line : 608 W BROWN ST
Second Line :
City : WAUPUN
State : WI
Zip : 53963-1788
Country : US
Telephone Number : 920-324-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2014
Last Update Date : 11/23/2020

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Directions to “ BRE ANNA MARIE NAGLE MD” Practice Location

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