Healthcare Provider Details

I. General information

NPI: 1346541752
Provider Name (Legal Business Name): ANN MARIE PAGEL RN, CCM, CHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 GLENDALEN RD
KRONENWETTER WI
54455-8830
US

IV. Provider business mailing address

2152 GLENDALEN RD
KRONENWETTER WI
54455-8830
US

V. Phone/Fax

Practice location:
  • Phone: 715-359-0274
  • Fax:
Mailing address:
  • Phone: 715-359-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104905-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: