Healthcare Provider Details

I. General information

NPI: 1780667071
Provider Name (Legal Business Name): KATHLEEN T NAGEL R.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E NAPLES CT
CHULA VISTA CA
91911-6821
US

IV. Provider business mailing address

700 E NAPLES CT
CHULA VISTA CA
91911-6821
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-6010
  • Fax: 619-205-1906
Mailing address:
  • Phone: 619-205-1480
  • Fax: 619-205-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN375983
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP11591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: