Healthcare Provider Details

I. General information

NPI: 1023358652
Provider Name (Legal Business Name): MS. MONICA LYNN NAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 W BIG BEAVER RD SUITE 520
TROY MI
48084-3407
US

IV. Provider business mailing address

2075 W BIG BEAVER RD SUITE 520
TROY MI
48084-3407
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-6659
  • Fax: 248-642-8645
Mailing address:
  • Phone: 248-646-6659
  • Fax: 248-642-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: