Healthcare Provider Details

I. General information

NPI: 1497612766
Provider Name (Legal Business Name): NICHOLE MARIE CAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE MARIE PALMER

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 3RD ST
DENMARK IA
52624-7701
US

IV. Provider business mailing address

PO BOX 45
DENMARK IA
52624-0045
US

V. Phone/Fax

Practice location:
  • Phone: 309-429-0908
  • Fax:
Mailing address:
  • Phone: 309-429-0908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number147264
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: