Healthcare Provider Details

I. General information

NPI: 1447480280
Provider Name (Legal Business Name): YANA T. NAGLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YANA TUROVSKAYA

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HUTCHINS DRIVE, SUITE 101 SOUTH LAKE PEDIATRICS
MINNETONKA MN
55345
US

IV. Provider business mailing address

17705 HUTCHINS DRIVE, SUITE 250 SOUTH LAKE PEDIATRICS
MINNETONKA MN
55345
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-8300
  • Fax: 952-401-8373
Mailing address:
  • Phone: 952-401-8300
  • Fax: 952-401-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54845
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: