Healthcare Provider Details

I. General information

NPI: 1962946483
Provider Name (Legal Business Name): JULIE PAGEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 W 143RD ST
ORLAND PARK IL
60462
US

IV. Provider business mailing address

674 FAIRWAY LN
FRANKFORT IL
60423-9018
US

V. Phone/Fax

Practice location:
  • Phone: 708-590-7150
  • Fax: 708-590-7151
Mailing address:
  • Phone: 715-574-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015119
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: