Healthcare Provider Details

I. General information

NPI: 1073500302
Provider Name (Legal Business Name): GREGORY NEAL CAGLE CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 E TUDOR RD STE 108
ANCHORAGE AK
99507-1166
US

IV. Provider business mailing address

500 SW 7TH ST STE A205
RENTON WA
98057-2983
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax: 833-888-7145
Mailing address:
  • Phone: 877-522-1275
  • Fax: 509-491-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-088261
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: