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General NPI Number Information
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NPI Number | 1053988436
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Entity Type | Individual
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Provider Name | CARYN NAGLAK FNP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2021
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | MIDWEST EXPRESS CLINIC 1923 W GLEN PARK AVE
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City | GRIFFIN
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State | IN
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Zip | 46319
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Country | US
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Telephone | 219-922-2535
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Fax |
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Provider Business Mailing Address
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Address Line | MIDWEST EXPRESS CLINIC 1923 W GLEN PARK AVE
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City | GRIFFIN
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State | IN
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Zip | 46319
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Country | US
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Telephone | 219-922-2535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.016454
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License Number State | IL
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