Healthcare Provider Details

I. General information

NPI: 1003316506
Provider Name (Legal Business Name): MS. WENDY SUE NAGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43909 30TH ST W
LANCASTER CA
93536-5843
US

IV. Provider business mailing address

43909 30TH ST W
LANCASTER CA
93536-5843
US

V. Phone/Fax

Practice location:
  • Phone: 661-575-5080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: